Blood glucose targets in the critically ill: is one size fits all still appropriate?

Abstract

In 2001, the paradigm for blood glucose control in hospitalised patients was challenged by a single-centre, randomised controlled trial (RCT). 1 van den Berghe G Wouters P Weekers F et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001; 345: 1359-1367 Crossref PubMed Scopus (8134) Google Scholar Conducted in mechanically ventilated surgical intensive care unit (ICU) patients (970 [63%] of 1548 following cardiovascular surgery and 1344 [87%] without a previous diagnosis of diabetes), this trial used intravenous insulin to target euglycaemia (blood glucose 80–110 mg/dL [4·4–6·1 mmol/L]) and dramatic reductions in mortality and morbidity were seen compared with patients in the control arm, in which intravenous insulin was administered only if blood glucose exceeded 215 mg/dL (11·9 mmol/L), with a target range of 180–200 mg/dL (10·0–11·1 mmol/L).