Diabetes Care in the Hospital: NICE-SUGAR Study (2)
Results of the NICE-SUGAR study1,2 are summarized on two slides Slide 2 of 2 Ninety-day mortality was significantly higher in the intensive versus the conventional group in both surgical and medical patients, as was mortality from cardiovascular causes Severe hypoglycemia was also more common in the intensively treated group (6.8% vs 0.5%; P<0.001); findings strongly suggest may it not be necessary to target blood glucose levels <140 mg/dL; a highly stringent target of <110 mg/dL may be dangerous In a recent meta-analysis of 26 trials (N=13,567) that included the NICE-SUGAR data, the pooled relative risk (RR) of death with intensive insulin therapy was 0.93 vs conventional therapy (95% CI 0.83–1.04)3 Approximately half of these trials reported hypoglycemia, with a pooled RR of intensive therapy of 6.0 (95% CI 4.5–8.0) The specific ICU setting influenced the findings; patients in surgical ICUs appearing to benefit from intensive insulin therapy (RR 0.63, 95% CI 0.44–0.91), while those in other medical and mixed critical care settings did not Overall, intensive insulin therapy appeared to increase risk of hypoglycemia but provided no overall benefit on mortality in the critically ill, although a possible mortality benefit to patients admitted to the surgical ICU was suggested140References American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care 2013;36(suppl 1):S46. Finfer S, Chittock Dr, Su SY, et al for the NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283-1297. Griesdale DE, de Souza RJ, van Dam RM, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ 2009;180:821–827.