Background
Randomized controlled trials have demonstrated both the benefits and harms of tight blood glucose control in patients in the intensive care unit (ICU). Variation in the use of early parenteral nutrition and in severe insulin-induced hypoglycemia could explain this inconsistency.
Methods
We randomly assigned patients, upon admission to the ICU, to liberal glucose control (insulin started only when blood glucose level was >215 mg per deciliter [>11.9 mmol per liter]) or to tight control. glucose (target blood glucose level using the LOGIC-Insulin algorithm of 80 to 110 mg per deciliter [4.4 to 6.1 mmol per liter]);
Parenteral nutrition was discontinued in both groups for 1 week. Adherence to the protocol was determined according to glucose metrics.
The primary outcome was the time needed for ICU care, calculated based on time to live discharge from the ICU, taking into account death as a competing risk; 90-day mortality was the safety outcome.
Results
Of 9230 patients who underwent randomization, 4622 were assigned to liberal glucose control and 4608 to strict glucose control.
The median morning blood glucose level was 140 mg per deciliter (interquartile range, 122 to 161) with liberal glucose control and 107 mg per deciliter (interquartile range, 98 to 117) with tight glucose control of glucose.
Severe hypoglycemia occurred in 31 patients (0.7%) in the liberal control group and 47 patients (1.0%) in the strict control group.
The time needed in the ICU was similar in the two groups (hazard ratio for early discharge alive with tight glucose control, 1.00; 95% confidence interval, 0.96 to 1. 04; P = 0.94).
90-day mortality was also similar (10.1% with liberal glucose control and 10.5% with strict glucose control, P = 0.51) .
Conclusions In critically ill patients not receiving early parenteral nutrition, tight glucose control did not affect duration of ICU care or mortality. |
(Funded by the Research Foundation–Flanders et al.; TGC-Fast ClinicalTrials.gov number, NCT03665207. opens in new tab.)
