Tight computerized versus conventional glucose control in the ICU: a randomized controlled trial.

Area of Science:

• Critical Care Medicine
• Endocrinology
• Medical Informatics

Background:

• Blood glucose control in intensive care units (ICUs) is debated.
• Computer decision support systems (CDSS) may enhance glucose management.

Purpose of the Study:

• To evaluate if tight computerized glucose control (TGC) improves outcomes compared to conventional glucose control (CGC) in ICU patients.
• To assess the impact of CDSS on mortality and hypoglycemia.

Main Methods:

• Multi-center randomized trial in 34 French ICUs.
• Adult ICU patients randomly assigned to TGC (target 4.4-6.1 mmol/L) or CGC (target <10.0 mmol/L) using CDSS.
• Primary outcome: 90-day all-cause mortality.

Main Results:

• No significant difference in 90-day mortality between TGC (32.3%) and CGC (34.1%) groups (p=0.32).
• Severe hypoglycemia (<2.2 mmol/L) was significantly higher in the TGC group (13.2%) versus CGC group (6.2%) (p<0.001).
• Baseline characteristics were similar across groups.

Conclusions:

• Tight computerized glucose control using CDSS did not reduce 90-day mortality in ICU patients.
• TGC was associated with a significantly higher incidence of severe hypoglycemia compared to conventional control.