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Intensive versus conventional glucose control in critically ill patients
The New England Journal of Medicine
|March 26, 2009
Summary
Intensive glucose control in intensive care units (ICUs) increased mortality compared to conventional control. A target blood glucose of 180 mg/dL or less is associated with lower mortality in critically ill adults.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Clinical Trials
Background:
- Optimal blood glucose targets for critically ill patients in intensive care units (ICUs) are not well-established.
- Glycemic control is a key concern in managing critically ill patients.
Purpose of the Study:
- To determine the optimal target range for blood glucose control in critically ill adults.
- To compare mortality rates between intensive and conventional glucose control strategies.
Main Methods:
- A large, international, randomized trial involving 6104 adult ICU patients.
- Patients were randomized to either intensive glucose control (81-108 mg/dL) or conventional glucose control (≤180 mg/dL).
- The primary endpoint was death from any cause within 90 days.
Main Results:
- Intensive glucose control resulted in higher mortality (27.5%) compared to conventional control (24.9%), with an odds ratio of 1.14 (P=0.02).
- Severe hypoglycemia (<40 mg/dL) was significantly more frequent in the intensive control group (6.8% vs 0.5%).
- No significant differences were observed in ICU stay, hospital stay, mechanical ventilation, or renal replacement therapy durations.
Conclusions:
- Intensive glucose control in critically ill adults is associated with increased mortality.
- A less stringent blood glucose target (≤180 mg/dL) is associated with lower mortality than a tighter target (81-108 mg/dL).
- The findings suggest that conventional glucose control is safer for critically ill patients.
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