Blood Sugar Control in the ICU
Before 2001 It was routine to ignore blood
glucose levels of 200 mg/dL (11.1 mmol/L)
Concern mounted when the blood sugar topped 250 mg/dl (14.2 mmol/L)
Action was likely when the blood sugar 300 mg/dl (16.8 mmol/L)
Proc Annu Symp Comput Appl Med Care. 1991:554-8.
6.9 7.8 mmol/L
Ann Thorac Surg 1999;67:352–62Deep sternal wound infection
11.1 mmol/L
Single Center – Surgical ICU
Outcome: Death in ICU Various secondary outcomes
Target = 80-110 mg/dl n=765
Target = 180-200 mg/dl n= 783
Continuous Glucose Monitoring and Control
Admit to SICU
Mean Glucose Levels
5.7mmol/L
8.5mmol/L
Intensive Conventional
Mean difference=50 mg/dl
Major Outcomes
p<.04 p<.01
About 750 patients/group
ORIGINALITY
IMPORTANCE
QUALITY
VALIDITY
Large multi-center trial started
NICE SUGAR
Primary outcome 90 Day mortality
Leuven #1-Published Nov 2001
2001 to 2009 Control of blood glucose in the ICU became a quality measure
ENDOCRINE PRACTICE Vol 10 No. 1 January/February 2004
Intensive Care Med. 2008 Jun;34(6):1160-2
Along the Way
Mixed results, possible harm
P=0.40
ORIGINALITY
IMPORTANCE
QUALITY
VALIDITY
Multicenter – All ICU types
Outcome: Death in 90 days Various secondary outcomes
Target = 80-108 mg/dl n=3054
Target = < 180 mg/dl n= 3050
Continuous Glucose Monitoring and Control
Admit to ICU
Mean difference=35 mg/dl
All-Cause Mortality
ORIGINALITY
IMPORTANCE
QUALITY
VALIDITY
N Engl J Med. 2010 Dec 23;363(26):2540-6.
JAMA Intern Med. 2015;175(5):801-809.