Landmark papers in critical care: Insulin

When diabetics get sick, their blood sugars shoot up to ungodly levels. Intuitively, it makes sense to keep their blood sugars within normal range because we like lab values that are normal. But is that really the best thing to do?

The NICE-SUGAR trial set out to examine this question. It enrolled over 6,000 patients in ICUs, almost all of whom were mechanically ventilated. Patients were divided into blood sugar goal groups of 81-108 or <180. Ultimately, the study found 90-day mortality was significantly higher in the 81-108 group, by about 3%, and that severe hypoglycemia was about 7% more common.




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