Intensive versus Conventional Glucose Control in Critically Ill Patients (NICE-SUGAR)
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Educational summary — always verify with primary sourceVan den Berghe (2001) showed intensive glucose control (80–110 mg/dL) reduced ICU mortality. NICE-SUGAR was the definitive large multicenter trial to test this.
Multicenter RCT (42 ICUs, Australia/New Zealand/Canada, n=6,104) comparing intensive glucose control (81–108 mg/dL) vs. conventional control (≤180 mg/dL) in critically ill patients.
Intensive glucose control increased 90-day mortality (27.5% vs 24.9%, OR 1.14, p=0.02). Severe hypoglycemia was much more common with intensive control (6.8% vs 0.5%). No difference in organ failure or ICU length of stay.
Tight glycemic control (80–110 mg/dL) is HARMFUL in ICU patients — it increases mortality due to hypoglycemia. Target blood glucose 140–180 mg/dL in critically ill patients. This is the current SSC and ADA recommendation. Avoid hypoglycemia at all costs.
Heterogeneous ICU population. Glucose monitoring frequency varied. Van den Berghe trial used different patient population (surgical ICU).
Classic reversal trial. Tight glucose control = harmful. Target 140–180 mg/dL. Know the contrast with Van den Berghe 2001.
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