Glucose Control in the ICU

This editorial examines the long-standing debate over optimal glucose targets for critically ill patients in intensive care units (ICUs). Early studies, such as the 2001 trial by Van den Berghe et al., suggested mortality benefits with tight glucose control (80–110 mg/dL), but subsequent multicenter trials (e.g., NICE-SUGAR) found no such benefits and instead highlighted risks of severe hypoglycemia. The 2023 trial by Gunst et al. (n=9,230) compared liberal glucose control (insulin initiated at >215 mg/dL) with tight control (80–110 mg/dL) and found no significant difference in ICU length of stay (primary outcome) or 90 day mortality (10.1% vs. 10.5%). Severe hypoglycemia rates were low (0.7–1.0%). The editorial concludes that while hyperglycemia should be managed to avoid extremes, intensive glucose control does not improve survival or ICU outcomes. Current guidelines recommend targeting 140–180 mg/dL for most critically ill patients, with stricter goals (100–180 mg/dL) only if achievable without hypoglycemia.

This editorial examines the long-standing debate over optimal glucose targets for critically ill patients in intensive care units (ICUs). Early studies, such as the 2001 trial by Van den Berghe et al., suggested mortality benefits with tight glucose control (80–110 mg/dL), but subsequent multicenter trials (e.g., NICE-SUGAR) found no such benefits and instead highlighted risks of severe hypoglycemia. The 2023 trial by Gunst et al. (n=9,230) compared liberal glucose control (insulin initiated at >215 mg/dL) with tight control (80–110 mg/dL) and found no significant difference in ICU length of stay (primary outcome) or 90 day mortality (10.1% vs. 10.5%). Severe hypoglycemia rates were low (0.7–1.0%). The editorial concludes that while hyperglycemia should be managed to avoid extremes, intensive glucose control does not improve survival or ICU outcomes. Current guidelines recommend targeting 140–180 mg/dL for most critically ill patients, with stricter goals (100–180 mg/dL) only if achievable without hypoglycemia.