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Benefits and Risks of Intensive Glucose Control in Intensive Care Units: A Meta-Analysis of Randomized Controlled
Yuanjie Duan1,2,3, Juan Liu1,2,3, Shiyu Lin1,2
1Hunan Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, School of Public Health, Changsha Medical University, Changsha, China.
Nursing in Critical Care
|July 30, 2026
Summary
Intensive glucose control in intensive care units (ICUs) does not improve survival but may reduce infection risk, especially in surgical patients. However, it significantly increases the risk of severe hypoglycemia.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Clinical Research Methodology
Background:
- Hyperglycaemia is a frequent complication in intensive care unit (ICU) patients, linked to higher mortality rates.
- The optimal strategy for glucose management in ICUs, balancing intensive versus liberal control, remains a subject of debate.
Purpose of the Study:
- To systematically evaluate and compare the efficacy and safety of intensive versus liberal glucose control strategies in ICU patients.
- To analyze the impact on mortality, infection rates, and other critical complications.
Main Methods:
- A comprehensive systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched major databases (PubMed, Cochrane, Embase, Web of Science) up to October 2024, adhering to PRISMA guidelines.
- Pooled relative risks using a random effects model and conducted trial sequential analysis for primary outcomes.
Main Results:
- Included 70 RCTs with 36,502 patients (adults and children).
- Intensive glucose control showed no significant difference in all-cause mortality for adults or children compared to liberal control.
- Intensive control significantly increased severe hypoglycemia risk (adults: RR 3.55; children: RR 5.70) but decreased infection risk (adults: RR 0.78; children: RR 0.83), particularly in surgical ICUs.
Conclusions:
- Intensive glucose control and liberal glucose control yield similar all-cause mortality outcomes in ICU patients.
- Intensive control offers a potential benefit in reducing infection risk, especially in surgical settings, but carries a notable risk of severe hypoglycemia.
- Routine intensive glucose control should be approached with caution, balancing its infection-reducing potential against the increased risk of hypoglycemia.
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