Critical Care Medicine-Endocrine Disorders>>>>>Diabetes Mellitus
Question 2#

Which of the following statements is FALSE regarding intensive glucose control (target blood glucose between 81 and 108 mg/dL) compared to conventional glucose control (target blood glucose <180 mg/dL) in critically ill patients.

A. Patients receiving intensive glucose control are 15 times more likely to develop hypoglycemia when compared to patients receiving conventional glucose control
B. Intensive glucose control is not associated with decreased mortality in surgical patients
C. Deaths from cardiovascular causes were more common in the intensive glucose control group than in the conventional glucose control group
D. Patients in the conventional glucose control group were more likely to have blood cultures positive for pathogenic organisms

Correct Answer is D

Comment:

Correct Answer: D

The NICE-SUGAR study was an international, multicenter trial involving 6,104 patients designed to test the hypothesis that intensive glucose control reduces mortality at 90 days. It found that intensive glucose control (target blood glucose between 81-108 mg/dL) was associated with a 2.6% increase in mortality at 90 days when compared to conventional glucose control (target blood glucose of <180 mg/dL). There were more hypoglycemic events in the intensive glucose control group. There was no difference between the two groups in overall length of stay, ICU length of stay, time on mechanical ventilation, time on renal replacement therapy, incidence of new organ failure, positive blood cultures, or red blood cell transfusions.

Although a previous trial showed intensive glucose control improved survival among surgical ICU patients, there was no difference in 90-day mortality in surgical and nonsurgical patients in the NICE-SUGAR trial.

References:

  1. Finfer S, Chittock DR, Blair D, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283- 1297.
  2. Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359-1367.