Letter

Recent literature regarding tight glycemic control: pitfalls in the sweet debate

Robert C Osburne¹ , Paul C Davidson¹ , Lawrence Stockton² , Marianne Baird³ , Lisa Kiblinger³ and R Dennis Steed⁴ for the Diabetes Special Interest Group of the Partnership for Health and Accountability

¹  Atlanta Diabetes Associates, 77 Collier Road #2080, Atlanta, GA 30309, USA

²  Piedmont Mountainside Hospital, 1266 Highway 515 South, Jasper, GA 30143, USA

³  Saint Josephs Hospital, 5665 Peachtree Dunwoody Road, N.E., Atlanta, GA 30342, USA

⁴  South Eastern Endocrinology and Diabetes, 1475 Holcomb Bridge Road, Suite 129, Roswell, GA 30076, USA

author email corresponding author email

Critical Care 2009, 13:408doi:10.1186/cc7750

Published:	30 April 2009

First paragraph (this article has no abstract)

Articles concluding that tight glycemic control (TGC) in the intensive care unit (ICU) has no mortality benefit and an unacceptably high rate of hypoglycemia have been published recently in several journals. The Diabetes Special Interest Group (DSIG) [1] believes that the data from some of these recent papers have been interpreted incorrectly, misconstrued, or misunderstood. The DSIG agrees with the scientists whose editorial comments were published with these articles [2,3] that the studies were underpowered to show a lack of benefit and agrees that hypoglycemia below 40 mg/dL is an undesirable complication. The incidence of hypoglycemia in these studies compares unfavorably with data from results with the Glucommander, which in published data has an overall hypoglycemia rate (below 40 mg/dL) of only 2.6% [4], and more recently, no blood sugar below 40 mg/dL was seen in patients on the Glucommander in the cardiovascular ICU [5]. Algorithms for achieving TGC are being continually refined. The target ranges for ICU patients are firmly established in only the post-cardiac surgical population. The DSIG joins others in the hope that the NICE-SUGAR (Normoglycemia in Intensive Care Evaluation – Survival Using Glucose Algorithm Regulation) trial (currently in the analysis phase, having enrolled over 6,000 subjects) will add to the knowledge base for these issues and also notes that the principal investigator for this study has commented that even a negative finding for benefit will not provide evidence in favor of abandoning glucose control entirely [6].