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Glycemic Control in Severe Acute Brain Injury: Systematic Review and Meta-analysis with Trial Sequential Analysis
Anne-Sophie Worm Fenger1, Markus Harboe Olsen2, Helene Ravnholt Jensen2
1Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark. anne-sophie.fenger.03@regionh.dk.
Neurocritical Care
|July 20, 2026
Summary
Strict versus liberal blood glucose control in intensive care unit (ICU) patients with acute brain injury shows no significant difference in mortality or neurological outcomes. Further large trials are needed to confirm these findings for hyperglycemia management.
Area of Science:
- Critical Care Medicine
- Neuroscience
- Endocrinology
Background:
- Hyperglycemia is prevalent in intensive care unit (ICU) patients, particularly those with acute brain injury.
- Existing research links hyperglycemia to increased mortality, but optimal blood glucose targets remain debated.
- This review focuses on severe acute brain injury patients within the ICU setting.
Purpose of the Study:
- To systematically compare strict versus liberal glycemic control strategies in ICU patients with acute brain injury.
- To evaluate the impact of different glycemic control targets on all-cause mortality.
- To assess neurological outcomes and health-related quality of life following acute brain injury.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials (RCTs) and observational studies.
- Searched multiple databases including CENTRAL, EMBASE, Medline, Web of Science, CINAHL, and trial registers.
- Utilized Trial Sequential Analysis (TSA) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess evidence certainty.
Main Results:
- Included 18 RCTs (3196 patients) and 13 observational studies (8354 patients).
- Meta-analysis indicated no significant difference in mortality (RR 0.95; 95% CI 0.84-1.08) or functional neurological outcome (RR 0.91; 95% CI 0.82-1.00) between strict and liberal glycemic control.
- Evidence certainty was low to very low; TSA suggested a need for additional trials, and no studies reported on quality of life.
Conclusions:
- Current low-certainty evidence suggests no discernible difference between strict and liberal glycemic control for mortality or functional outcomes in severe acute brain injury.
- The potential benefits of strict glycemic control in this patient population remain uncertain.
- Large, low-bias RCTs are recommended to enhance the certainty of evidence regarding hyperglycemia management.
