BMJ  2006;332:865-866 (15 April), doi:10.1136/bmj.332.7546.865

Editorial

Strict glucose control in the critically ill

May not be such a good thing for all critically ill patients

The first 150 words of the full text of this article appear below.

In 2001 Van den Berghe et al reported the results of a randomised controlled trial comparing the mortality of critically ill surgical patients receiving insulin infusions to achieve "tight glycaemic control" (target blood glucose 4.4-6.1 mmol/l) with that of patients receiving conventional treatment, where insulin was infused only if the blood glucose exceeded 11.9 mmol/l and was adjusted to maintain values of 10-11.1 mmol/l.¹ The trial was stopped after 1548 patients had been enrolled because the mortality in the tight control group was 4.6% compared with 8% in the control group (32% corrected relative reduction; P = 0.04). Ever since, tight glycaemic control has been standard practice, but there are now good reasons to question it.

It always seemed surprising that a simple change in blood glucose management reduced mortality more than other far more costly and complex interventions tested through randomised trials in the critically ill. The only . . . [Full text of this article]

ICS Trials Group, Adult Intensive Care Unit, John Radcliffe Hospital, Oxford OX3 9DU
(peter.watkinson@nda.ox.ac.uk)

ICS Trials Group, Adult Intensive Care Unit, John Radcliffe Hospital, Oxford OX3 9DU

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• Penfold, S., Gouni, R., Hamilton, P., Richardson, T., Kerr, D. (2008). Immediate in-patient management of hyperglycaemia--confusion rather than consensus?. QJM 101: 87-90 [Abstract] [Full text]  
• Asadollahi, K., Beeching, N., Gill, G. (2006). Hyponatraemia as a risk factor for hospital mortality.. QJM 99: 877-880 [Abstract] [Full text]  

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