Intensive Glucose Control Spikes Mortality in Critically Ill
Hypoglycemia also soars in study group in large international trial
TUESDAY, March 24 (HealthDay News) -- Intensively controlling blood glucose in a study group of critically ill patients increased their mortality rate and hypoglycemia in comparison to a group receiving conventional glucose control, according to research reported online March 24 in advance of publication in the March 26 issue of the New England Journal of Medicine.
The research by Simon Finfer, of the George Institute for International Health in Sydney, Australia, and co-investigators participating in the large-scale study Normoglycemia in Intensive Care Evaluation--Survival Using Glucose Algorithm Regulation (NICE-SUGAR), randomized 6,104 intensive care patients to two groups: 3,054 with intensive glucose control (target range 81 to 108 mg per deciliter) and 3,050 with conventional glucose control (target range 180 mg per deciliter or less). The glucose level was maintained with insulin using a complex treatment algorithm standardized for all 42 participating medical centers. The study endpoint was death from all causes within 90 days.
At endpoint, 829 patients (27.5 percent) in the intensively controlled group and 751 (24.9 percent) in the conventionally controlled group had died. The leading cause of death in the intensively controlled group was cardiovascular failure, the investigators found. Severe hypoglycemia (≤40 mg per deciliter) was diagnosed in 206 of 3,016 patients (6.8 percent) who stayed on treatment in the intensively controlled group and 15 of 3,014 (0.5 percent) in the conventionally controlled group, the researchers report.
"These differences might suggest that reducing blood glucose levels by administration of insulin has adverse effects on the cardiovascular system. However, our trial was not designed to examine such mechanisms: further research is needed to understand the increased mortality in our trial," the authors write.