Glucose Control in the ICU: More Studies, Ongoing Uncertainty

Based largely on a single trial in a surgical intensive care unit (JW Nov 16 2001), several professional organizations have endorsed tight glucose control in critically ill patients generally. However, subsequent studies in broader populations of critically ill patients have yielded mixed results. A meta-analysis and two large observational studies have now been published.

The meta-analysis included 29 randomized trials with 8432 critically ill patients and used two definitions of tight control (≤110 mg/dL or 111–150 mg/dL). No difference in short-term mortality was noted between patients who received tight control (by either definition) and those who received usual care. Among septicemia patients, in-hospital mortality was about 20% lower w…