Document Detail


Intensive versus conventional glucose control in critically ill patients.
MedLine Citation:
PMID:  19318384     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The optimal target range for blood glucose in critically ill patients remains unclear.
METHODS: Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter (4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per deciliter (10.0 mmol or less per liter). We defined the primary end point as death from any cause within 90 days after randomization.
RESULTS: Of the 6104 patients who underwent randomization, 3054 were assigned to undergo intensive control and 3050 to undergo conventional control; data with regard to the primary outcome at day 90 were available for 3010 and 3012 patients, respectively. The two groups had similar characteristics at baseline. A total of 829 patients (27.5%) in the intensive-control group and 751 (24.9%) in the conventional-control group died (odds ratio for intensive control, 1.14; 95% confidence interval, 1.02 to 1.28; P=0.02). The treatment effect did not differ significantly between operative (surgical) patients and nonoperative (medical) patients (odds ratio for death in the intensive-control group, 1.31 and 1.07, respectively; P=0.10). Severe hypoglycemia (blood glucose level, < or = 40 mg per deciliter [2.2 mmol per liter]) was reported in 206 of 3016 patients (6.8%) in the intensive-control group and 15 of 3014 (0.5%) in the conventional-control group (P<0.001). There was no significant difference between the two treatment groups in the median number of days in the ICU (P=0.84) or hospital (P=0.86) or the median number of days of mechanical ventilation (P=0.56) or renal-replacement therapy (P=0.39).
CONCLUSIONS: In this large, international, randomized trial, we found that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg or less per deciliter resulted in lower mortality than did a target of 81 to 108 mg per deciliter. (ClinicalTrials.gov number, NCT00220987.)
Authors:
; Simon Finfer; Dean R Chittock; Steve Yu-Shuo Su; Deborah Blair; Denise Foster; Vinay Dhingra; Rinaldo Bellomo; Deborah Cook; Peter Dodek; William R Henderson; Paul C Hébert; Stephane Heritier; Daren K Heyland; Colin McArthur; Ellen McDonald; Imogen Mitchell; John A Myburgh; Robyn Norton; Julie Potter; Bruce G Robinson; Juan J Ronco
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-03-24
Journal Detail:
Title:  The New England journal of medicine     Volume:  360     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-26     Completed Date:  2009-03-31     Revised Date:  2014-03-17    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1283-97     Citation Subset:  AIM; IM    
Copyright Information:
2009 Massachusetts Medical Society
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00220987
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use
Blood Glucose* / analysis
Critical Illness / mortality,  therapy*
Female
Humans
Hyperglycemia / drug therapy*
Hypoglycemia / chemically induced
Hypoglycemic Agents / adverse effects,  therapeutic use*
Insulin / adverse effects,  therapeutic use*
Intensive Care / methods*
Intensive Care Units
Kaplan-Meier Estimate
Length of Stay
Male
Middle Aged
Grant Support
ID/Acronym/Agency:
10293//Cancer Research UK
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Blood Glucose; 0/Hypoglycemic Agents; 0/Insulin
Investigator
Investigator/Affiliation:
S Finfer / ; D Blair / ; R Bellomo / ; C McArthur / ; I Mitchell / ; J Myburgh / ; R Norton / ; J Potter / ; D Chittock / ; V Dhingra / ; D Foster / ; D Cook / ; P Dodek / ; P Hébert / ; W Henderson / ; D Heyland / ; E McDonald / ; J Ronco / ; I Schweitzer / ; R Peto / ; P Sandercock / ; C Sprung / ; J D Young / ; S Su / ; S Heritier / ; Q Li / ; S Bompoint / ; L Billot / ; L Crampton / ; F Darcy / ; K Jayne / ; V Kumarasinghe / ; L Little / ; S McEvoy / ; S MacMahon / ; S Pandey / ; S Ryan / ; R Shukla / ; B Vijayan / ; S Atherton / ; J Bell / ; L Hadfield / ; C Hourigan / ; C McArthur / ; L Newby / ; C Simmonds / ; H Buhr / ; M Eccleston / ; S McGuinness / ; R Parke / ; R Bellomo / ; S Bates / ; D Goldsmith / ; I Mercer / ; K O'Sullivan / ; R Gazzard / ; D Hill / ; C Tauschke / ; D Ghelani / ; K Nand / ; G Reece / ; T Sara / ; S Elliott / ; D Ernest / ; A Hamilton / ; R Ashley / ; A Bailey / ; E Crowfoot / ; J Gissane / ; I Mitchell / ; J Ranse / ; J Whiting / ; K Douglas / ; D Milliss / ; J Tan / ; H Wong / ; D Blythe / ; A Palermo / ; M Hardie / ; P Harrigan / ; B McFadyen / ; S Micallef / ; M Parr / ; A Boase / ; J Tai / ; A Williams / ; L Cole / ; I Seppelt / ; L Weisbrodt / ; S Whereat / ; A Flanagan / ; J Liang / ; F Bass / ; M Campbell / ; N Hammond / ; L Nicholson / ; Y Shehabi / ; J Foote / ; S Peake / ; P Williams / ; R Deans / ; C Fourie / ; M Lassig-Smith / ; J Lipman / ; J Stuart / ; A Bell / ; T Field / ; R McAllister / ; K Marsden / ; A Turner / ; S Ankers / ; S Bird / ; S Finfer / ; R Lee / ; A O'Connor / ; J Potter / ; N Ramakrishnan / ; R Raper / ; V Dhiacou / ; K Girling / ; A Jovanovska / ; J Myburgh / ; N Groves / ; J Holmes / ; J Santamaria / ; R Smith / ; S Baker / ; B Roberts / ; L Andrews / ; R Dinsdale / ; R Fenton / ; D Mackle / ; S Mortimer / ; C French / ; L Little / ; H Raunow / ; M Gales / ; F Hill / ; S Rachakonda / ; D Rogan / ; C Allsop / ; L Higgins / ; B Robinson / ; K Champagne / ; C Doig / ; L Knox / ; P Taylor / ; C Wilson / ; J Drover / ; S Hammond / ; E Mann / ; M Myers / ; A Robinson / ; J Harvey / ; Y Skrobik / ; A Baumgartner / ; L Meade / ; N Vlahakis / ; C Ethier / ; M Kramer-Kile / ; S Mehta / ; C Gaudert / ; S Kanji / ; T McArdle / ; I Watpool / ; F Clarke / ; D Cook / ; E McDonald / ; A Tkaczyk / ; J Marshall / ; J Morrissey / ; K Porretta / ; O Smith / ; V Wen / ; B J Ashley / ; P Dodek / ; S Mans / ; B Bojilov / ; K Code / ; R Fowler / ; N Marinoff / ; L Chu / ; J Granton / ; M McGrath-Chong / ; M Steinberg / ; N Ferguson / ; S Go / ; A Matte / ; J Rosenberg / ; J Stevenson / ; M Jacka / ; L Sonnema / ; R Autio / ; D Chittock / ; D Davies / ; P Ganz / ; M Gardner / ; S Logie / ; L Smith / ; L Atkins / ; F Auld / ; M Stewart / ; G Wood /
Comments/Corrections
Comment In:
Can J Anaesth. 2010 Feb;57(2):172-5   [PMID:  20043219 ]
Curr Infect Dis Rep. 2009 Sep;11(5):335-6   [PMID:  19698275 ]
Internist (Berl). 2010 May;51(5):670, 672-3   [PMID:  20352176 ]
N Engl J Med. 2009 Mar 26;360(13):1346-9   [PMID:  19318385 ]
N Engl J Med. 2009 Jul 2;361(1):90; author reply 91-2   [PMID:  19579274 ]
N Engl J Med. 2009 Jul 2;361(1):89-90; author reply 91-2   [PMID:  19579271 ]
N Engl J Med. 2009 Jul 2;361(1):89; author reply 91-2   [PMID:  19571290 ]
N Engl J Med. 2009 Jul 2;361(1):90; author reply 91-2   [PMID:  19579272 ]
N Engl J Med. 2009 Jul 2;361(1):91; author reply 91-2   [PMID:  19579275 ]
J Fam Pract. 2009 Aug;58(8):424-6   [PMID:  19679022 ]
Ann Intern Med. 2009 Aug 18;151(4):JC2-5   [PMID:  19687479 ]
N Engl J Med. 2009 Jul 2;361(1):90-1; author reply 91-2   [PMID:  19579273 ]
Curr Hypertens Rep. 2009 Dec;11(6):383-4   [PMID:  19895748 ]

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