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• W2417811395 abstract "New guidelines for inpatient glycemic control, published as a consensus statement from the American Association of Clinical Endocrinologists and the American Diabetes Association in the May/June 2009 issue of this journal ( 1. Moghissi E.S. Korytkowski M.T. DiNardo M. et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009; 15: 353-369 Abstract Full Text Full Text PDF PubMed Scopus (429) Google Scholar ), recommend raising the desired blood glucose (BG) goal in critical care units from 80 to 110 mg/dL to 140 to 180 mg/dL. This adjustment is based on the recent publication of the Normoglycemia in Intensive Care Evaluation—Survival Using Glucose Algorithm Regulation (NICE-SUGAR) study ( 2. Finfer S. Chittock D.R. Su S.Y. et al. (NICE-SUGAR Study Investigators). Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009; 360: 1283-1297 Crossref PubMed Scopus (0) Google Scholar ), which demonstrated a higher mortality in the intensively controlled population in comparison with that in a control group. Several important details of the study, however, should be noted. First, “intensive control” was defined as BG levels between 80 and 110 mg/dL, and the control group consisted of those with BG values between 110 and 180 mg/dL. In the control group, however, the mean BG was 144 mg/dL, and insulin infusion was discontinued when the BG level reached 144 mg/dL. Second, surgical patients, especially those undergoing coronary artery bypass grafting procedures, were limited in this study. The advantages of intensive glycemic control (BG values between 80 and 110 mg/dL) in such patients have been documented earlier ( 3. Griesdale D.E. de Souza R.J. van Dam R.M. et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ. 2009; 180: 821-827 Crossref PubMed Scopus (842) Google Scholar ). Third, an important adverse consequence of intensive glycemic control is known to be hypoglycemia. The rate of occurrence of hypoglycemia in the intensively controlled group was reported to be 6.8%, but closer subgroup analysis of all the cases of hypoglycemia in the NICE-SUGAR study reveals that such episodes were explained by clinician error in 37% and by nutrition issues in 24% ( 4. Clark N. Finfer S. (NICE-SUGAR Study Investigators) Regulation (NICE-SUGAR) study: analysis of the first 100 hypoglycaemic events. 2009 Google Scholar ). Finally, the study was primarily conducted in Australia and Canada and may not be representative of clinical practice in the United States." @default.
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• W2417811395 date "2009-11-01" @default.
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• W2417811395 title "Arbitrary “Relaxation” of Guidelines for Inpatient Glycemic Control?" @default.
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