WHAT’S NEW: Now we know: Don’t go too low
This study, in contrast to a number of smaller studies of lower quality, demonstrates a higher all-cause mortality rate at 90 days for critically ill patients receiving intensive glucose therapy. It is now clear that, among critically ill hospitalized patients, aiming for intensive glucose control (81-108 mg/dL) is associated with an increased rate of severe hypoglycemic events and all-cause mortality at 90 days. The previously used goal of conventional therapy (≤180 mg/dL) is safer.
CAVEATS: Study population may not reflect primary care
There are 2 caveats to this study. The first is that because of the nature of the research, it was impossible to maintain blinding of the clinical staff to patient assignments. The second important caveat pertains to the severity of illness among participants in this multicenter study: Most of these patients were in ICUs at tertiary care medical centers and had an expected ICU length of stay of 3 or more days. Although many family physicians manage patients in ICUs, the patients randomized in this study may represent a sicker than average patient population for some hospitals.
CHALLENGES TO IMPLEMENTATION: Some may doubt validity of this outcome
Less aggressive glycemic control for critically ill patients should be easier to achieve, not more difficult. However, a change in glucose targets may require new admission order sets and, notably, reeducation of physicians and nurses who have been convinced by earlier studies that more intensive glucose control is superior.
Acknowledgments
The PURLs Surveillance System is supported in part by Grant Number UL1RR024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
PURLs methodology
This study was selected and evaluated using FPIN’s Priority Updates from the Research Literature (PURL) Surveillance System methodology. The criteria and findings leading to the selection of this study as a PURL can be accessed at www.jfponline.com/purls.
