Van den Berghe / Leuven (2001)

Hyperglycemia is common in critically ill patients and is associated with adverse outcomes. Prior to this study, the optimal glucose target in the ICU was unknown, leading to the question of whether strict glycemic control could improve patient outcomes.

This was a prospective, randomized, controlled trial conducted in a surgical intensive care unit (SICU) in Belgium. 1548 critically ill surgical patients were randomized to either intensive insulin therapy (target glucose 80-110 mg/dL) or conventional treatment (insulin given if glucose >215 mg/dL, targeting 180-200 mg/dL). The primary endpoint was in-hospital mortality.

Intensive insulin therapy significantly reduced in-hospital mortality from 8.0% to 4.6% (p<0.005). This reduction was primarily seen in patients who stayed in the ICU for more than 5 days. Intensive insulin also reduced morbidity, including a lower incidence of sepsis, acute renal failure requiring dialysis, and critical illness polyneuropathy.

Intensive insulin therapy targeting strict glycemic control (80-110 mg/dL) in critically ill surgical patients can reduce mortality and morbidity.

The study was single-center and conducted in a surgical ICU, limiting generalizability to medical ICU patients. Subsequent trials, particularly NICE-SUGAR, showed harm with similar strict targets, suggesting the optimal glucose target may be higher than initially thought.