NICE-SUGAR and Glucose Control in the Critically Ill
Hypergycemia is associated with increased morbidity and mortality in hetergeneous populations of critically ill patients.
Over the past few years there has been great interest in aggressively controlling glucose through the use of continuous insulin infusions.
Results of recent trials and meta-analyses, however, question the benefit of tight glucose control and highlight the marked increase in severe hypoglycemia rates.
Recently, the results of the NICE-SUGAR study were published, the largest trial to date (6000 patients)evaluating intensive vs. conventional glucose control in the critically ill.
Investigators found an INCREASED mortality among adults randomized to intensive glucose control
Given the lack of benefit, potential harm, risks of severe hypoglycemia, and resource utilization, intensive glucose control should not be a therapy routinely implemented in the ED.
References
The NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. NEJM 2009;360(13):1283-1348.
