Tight blood sugar control fails to Impact Outcomes in patients not receiving early parenteral nutrition: NEJM

In critically sick patients who did not receive early parenteral nutrition, tight glucose control had no impact on the duration of required ICU care or mortality rates, says an article published in New England Journal of Medicine. The study involved over 9,000 patients, aimed to address the ongoing debate about the benefits and risks of tight blood-glucose control in the ICU.

The study assigned patients upon ICU admission to one of two groups: liberal glucose control or tight glucose control. The liberal group only initiated insulin treatment when blood glucose levels exceeded 215 mg per deciliter, while the tight control group used the LOGIC-Insulin algorithm to maintain blood glucose levels between 80 to 110 mg per deciliter. Additionally, both groups refrained from using parenteral nutrition for one week.

The results of the trial are eye-opening. Among the 9,230 patients enrolled, there was no significant difference in the length of ICU stay between the two groups. This finding suggests that tight glucose control did not result in shorter ICU stays. Furthermore, the 90-day mortality rate was almost identical in both groups, with 10.1% for liberal glucose control and 10.5% for tight glucose control. This indicates that tight glucose control did not have a significant impact on patient survival.

The study also found that the incidence of new infections, the duration of respiratory and hemodynamic support, the time to discharge alive from the hospital, and ICU and hospital mortality rates were similar between the two groups. However, tight glucose control seemed to have a positive effect in reducing the prevalence of severe acute kidney injury and cholestatic liver dysfunction.

One of the remarkable aspects of this research is that it sheds light on the importance of context in medical treatments. The absence of early parenteral nutrition might explain why these findings differ from some previous studies that suggested potential benefits of tight glucose control.

Reference:

Gunst, J., Debaveye, Y., Güiza, F., Dubois, J., De Bruyn, A., Dauwe, D., De Troy, E., Casaer, M. P., Haghedooren, R., Jacobs, B., Meyfroidt, G., Wouters, P. J., Stessel, B., … Van den Berghe, G. (2023). Tight Blood-Glucose Control without Early Parenteral Nutrition in the ICU. In New England Journal of Medicine (Vol. 389, Issue 13, pp. 1180–1190). Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2304855