Trial

Study Design

Patients

Comparator Groups

Findings

Comments

NICE-SUGAR study investigators. [25]

Randomized post-hoc analysis

Critically-ill patients in intensive care units (N = 6026)

Intensive glucose control:

BG range 81 - 108 mg/dL

Conventional glucose control:

Target 180 mg/dL or less

Mortality:

No difference between groups

Morbidity:

Moderate/severe hypoglycemia correlated with longer ICU stays

Mortality increased in moderate/severe hypoglycemia, regardless of treatment group

Griesdale, DEG; et al. [26]

Meta-analysis of 26 trials

Critically-ill patients in intensive care units

--

Intensive glucose control had no effect on the overall mortality rate

Intensive insulin therapy may be beneficial to patients admitted to a surgical ICU

NICE-SUGAR study investigators. [27]

Randomized post-hoc analysis

Critically-ill patients in intensive care units (N = 6026)

Moderate hypoglycemia:

BG range 41 - 70 mg/dL

Severe hypoglycemia:

BG range

40 mg/dL or less

Length of Stay:

Increased for those experiencing moderate or severe hypoglycemia

Mortality:

No difference between groups

No causal relationship could be established, but an association was found between hypoglycemic events and death.

NICE-SUGAR study investigators. [28]

International randomized- controlled trial subgroup follow-up analysis

Traumatic brain injury (TBI) patients in intensive care units (N = 391)

Intensive glucose control:

BG range 81 - 108 mg/dL

Conventional glucose control:

Target 180 mg/dL or less

Mortality:

No difference between groups

Morbidity:

Glasgow outcomes score unchanged between groups

Follow-up of TBI patients who participated in the NICE-SUGAR study.

Krinsley, JS. [29]

Literature review of observational cohort studies

Critically-ill patients in intensive care units

--

Hypoglycemia, hyperglycemia, and more glucose variability are each associated with increased risk of death.

Time in range >80% for nondiabetics is strongly and independently associated with survival.

Limiting glucose variability and improving the time within the goal range may be the key target to improving outcomes.

Perez, A; et al. [18]

Meta-analysis

Hospitalized patients, both critically and non-critically ill

--

Extremes of blood glucose led to poor outcomes. A target glucose range of 110 - 180 mg/dL is most appropriate for critically ill and noncritically ill patients.

Continuous intravenous insulin infusion is preferred for critically ill patients and scheduled basal-bolus-correction insulin is preferred in noncritically ill patients.