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Is Strict Glycemic Control Beneficial for Critically Ill Patients?

There is little evidence that tight control of blood glucose improves outcomes among hospitalized patients, but this issue has not been addressed in large trials. Therefore, Belgian investigators randomized 1548 patients in a surgical intensive care unit to either intensive treatment (insulin infusion started if blood glucose exceeded 110 mg/dL; goal, 80–110 mg/dL) or conventional treatment (insulin infusion started if blood glucose exceeded 215 mg/dL; goal, 180–200 mg/dL). Sixty-three percent of patients were admitted to the ICU after cardiac surgery, and 13 percent had diabetes.

During patients' ICU stays, mean morning glucose levels were 103 mg/dL and 153 mg/dL in the intensively and conventionally treated groups, respectively. Death rates were significantly lower in the intensive group than in the conventional group, both during the ICU stay alone (4.6 percent vs. 8.0 percent) and throughout the hospitalization (7.2 percent vs. 10.9 percent). Reduced mortality in the intensive group was largely attributable to fewer deaths from multiple organ failure with a proven septic focus. The mortality benefit was confined to patients whose ICU stays exceeded 5 days.

Comment: These remarkable results suggest that a relatively low-tech intervention has the potential to reduce ICU mortality. However, an editorialist notes 2 important caveats: First, the study could not be performed in a blinded fashion; intensively treated patients might have received other beneficial interventions that were not captured in this analysis. Second, because enrollees in this study were mainly cardiac surgery patients, the editorialist calls for studies in other patient populations before this treatment is implemented generally.

— AS Brett

Published in Journal Watch General Medicine November 16, 2001

Citation(s):

Van den Berghe G et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001 Nov 8 345 1359-1367.

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Evans TW. Hemodynamic and metabolic therapy in critically ill patients. N Engl J Med 2001 Nov 8 345 1417-1418.

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