Intensive blood glucose control in the ICU is not helpful (TGC-FAST trial)
Finally, the end of intensive insulin therapy in the ICU
Hyperglycemia is associated with worse outcomes in the ICU (and in medical patients generally), so correcting it must improve outcomes … right?
After two studies published in NEJM 2001 and 2006 showed intensive glucose control (to 80-110 g/dL) improved outcomes in adult medical and surgical patients, and then in kids (all at a single center in Leuven, Belgium), tight glucose control quickly became standard care in the U.S. and many other countries.
A large multicenter study was launched to test this finding. Called NICE-SUGAR (NEJM 2009), conducted at 42 hospitals in Australia and New Zealand, it found that intensive glucose control actually harmed people, by frequently inducing severe hypoglycemia. (There were 78 excess deaths with a number needed to harm of about 39 in the intensive glucose control group.) Reams of insulin drip protocols became confetti. Critical care settled on a middle-ground blood glucose target of 140-180 g/dL for most patients.
Now, Dr. Greet van den Berghe and h…
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