NICE-SUGAR

The highly anticipated NICE-SUGAR study results are finally published. This study was aimed to answer the ever-evolving question of how 'tight' should glucose control be in the ICU setting? After the Leuven study was published in th NEJM in 2001 suggesting a mortality benefit, many intensive care units adopted their very strict goals, of keeping the glucose less than 110 mg/dL. 5 years later, the 2nd Leuven study (also published in NEJM) did not show a similar finding but this did not seem to deter many people from aiming for such a low glucose goal in the ICU. One reasoning was that the hypoglycemia seen in the intensive group was considered to be under controlled conditions and were 'minor'.

The NICE-SUGAR study seems to blow the earlier findings out of the water: The investigators found that patients randomized to tighter control (glucose 81-108 mg/dL) had a higher 90-day all-cause mortality rate compared to conventional control (less than 180 mg/dL). While the causes of death were similar between groups, the intensive group did have a higher cardiac outcome, suggesting that hypoglycemia may very well be a factor.
Many endocrinologists and intensivists have been holding their breaths anxiously awaiting the results of this highly anticipated study. With these findings, we may very well have to rethink our approach to treating ICU patients. It'll be interesting to see how ICUs worldwide respond to this study.