Hypoglycemia in the Critically Ill: How Low Is Too Low?
Mayo Clin Proc. 2010 Feb 22;
Authors: Krinsley JS, Keegan MT
Tight glycemic control in critically ill patients became a therapeutic paradigm after the 2001 publication of a landmark single-center interventional trial in Leuven, Belgium, (ie, "Leuven 1") that targeted euglycemia in a population of mechanically ventilated patients in a surgical intensive care unit (ICU).(1) A subsequent randomized trial from the same institution in medical patients(2 )(ie, "Leuven 2") was not as strongly positive for the benefits of intensive insulin therapy as the first study. Two later interventional studies were terminated prematurely by their respective institutional review boards and were underpowered to show any effect on mortality.(3,4) Meta-analysis failed to demonstrate a survival benefit for tight glycemic control.(5) Finally, in the large multicenter NICE-SUGAR (Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation) trial, the control group with a moderate glycemic target range of 140 to 180 mg/dL had lower 90-day mortality than did the interventional group with a glycemic target range of 81 to 108 mg/dL.(6) What went wrong?
PMID: 20176927 [PubMed - as supplied by publisher]