Critical care review: the high price of sugar

• Main Authors: Singarajah CU, Robbins RA
• Format: Article
• Language: English
• Published: Arizona Thoracic Society 2011-10-01
• Series: Southwest Journal of Pulmonary and Critical Care
• Subjects: glucose; Institute of Healthcare Improvement; Joint Commission of Healthcare Organizations; evidence based; guidelines; hyperglycemia; hypoglycemia; intensive control
• Online Access: http://www.swjpcc.com/critical-care/2011/10/18/critical-care-review-the-high-price-of-sugar.html?SSScrollPosition=282

The intensive control of blood glucose had been proposed to be important in increasing survival in the intensive care unit (ICU) despite only one positive randomized trial. The concept was supported by guidelines released by several regulatory organizations including the Joint Commission of Healthcare Organizations and the Institute of Healthcare Improvement. However, the large, randomized, multi-center NICE-SUGAR trial published in 2009 showed tight control of glucose in the ICU is actually hazardous with a 14% increase in mortality. The historical basis and data used to support intense control of glucose in the ICU are reviewed and illustrate the harm that can result when guidelines are based on weak evidence.