2 Oct 2023 • In critically ill patients, hyperglycemia is often associated with poor outcomes. A randomized controlled trial investigated the impact of different blood glucose control strategies in critically ill patients within the intensive care unit (ICU) who were not receiving early parenteral nutrition.

• The study, published in the New England Journal of Medicine, divided 9,230 patients into two groups: one receiving liberal glucose control (insulin initiated when blood glucose exceeded 215 mg/dL) and the other receiving tight glucose control (targeting blood glucose levels between 80 to 110 mg/dL using the LOGIC-Insulin algorithm). Both groups had parenteral nutrition withheld for a week.
• The results showed that there was no significant difference in the length of ICU stay between the two groups, and 90-day mortality rates were also similar (10.1% with liberal glucose control and 10.5% with tight glucose control).
• The study's secondary outcomes indicated that the incidence of new infections, the duration of respiratory and hemodynamic support, time to discharge alive from the hospital, and ICU and hospital mortality rates were comparable between the two groups.
• Interestingly, tight glucose control appeared to reduce the prevalence of severe acute kidney injury and cholestatic liver dysfunction.

In conclusion, in critically ill patients who were not receiving early parenteral nutrition, tight glucose control did not affect the length of time that ICU care was needed or mortality.

Source: NEJM | Read full story