More-Liberal Glucose Control in Critically Ill Diabetic Patients?

In the early 2000s, a movement began to tightly control glucose levels (target level, <110 mg/dL) in critically ill patients. Subsequent studies revealed potential harm with this approach (NEJM JW Gen Med Apr 15 2009 and N Engl J Med 2009; 360:1283; NEJM JW Gen Med Mar 1 2006 and N Engl J Med 2006; 354:449), and more-moderate glucose goals (i.e., 110–180 mg/dL) became the standard of care. Is this standard still too tight for critically ill diabetic patients? Observational data suggest excess hypoglycemia and mortality, even at this target, in critically ill patients.

Australian investigators examined 700 diabetic patients who were admitted to a single mixed medical/surgical intensive care unit (ICU); half received care with a conventional g…