Glycaemic control in intensive care: Everything in moderation.

Abstract

Glycaemic control is an important predictor of mortality in sepsis. Various international organizations including the Surviving Sepsis campaign recommend glycaemic control in critical illness with a glucose target between 6.1-10 mmol/L. The NICE-SUGAR Trial in 2009 was a landmark in the debate over tight versus liberal glycaemic control in the critically ill and subsequent guidelines have been adjusted to reflect a move towards moderate glycaemic control. We conducted a nation-wide study comparing glucose targets used in intensive care units in the United Kingdom in 2007 with those used in 2014 to 2015 to see the impact of the NICE-SUGAR study and subsequent guideline changes. We received a combined response from 81% of intensive care units in the UK. There was an increase in the average median glucose target in 2014/2015 compared with 2007 (7.8 versus 7.2; p < 0.01). However, there is still much variability in glucose targets used in critical care in the UK. There is an overall trend towards using a more moderate glucose target in critical care in the UK reflecting changes in international guidelines. However, it is likely that controversies, which still exist in the literature, are reflected in the variability of glycaemic control targets. It is possible that the advent of closed-loop or continuous glucose monitoring may have a further impact on this.