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.