NICE SUGAR investigators publish important new study

The New England Journal of Medicine this week published the results of a study into whether hypoglycemia leads to death in critically ill patients. Professor Simon Finfer, of The George Institute for Global Health, led investigators in this second study, which provided an important new analysis of the Normoglycemia in Intensive Care Evaluation–Survival Using Glucose Algorithm Regulation (NICE SUGAR) trial data.

Professor Finfer said the NICE SUGAR trial, completed between 2004 and 2008, provided a significant database of information from more than 6000 participants and the present study was a post hoc analysis of that data.

The new analysis provides further evidence of the importance of blood glucose in determining whether patients survive a period of critical illness. Efforts to tightly control blood glucose have invariably resulted in some patient’s blood glucose being lower than generally considered safe. Hypoglycemia, an abnormally low blood glucose concentration, is thought to be harmful but its exact role in critically ill patients remains hotly debated.

“Our findings confirmed that among critically ill patients, moderate and severe hypoglycemia are both strongly associated with an increased risk of death and that the risk is greater among patients who have severe hypoglycemia and among those who have moderate hypoglycemia on more than one day,” Professor Finfer said.

“In some patients, particularly those in whom hypoglycemia occurs in the absence of insulin therapy, hypoglycemia appears to be a marker of impending death rather than a cause of subsequent death, but overall it is likely that inducing hypoglycemia with insulin treatment is harming patients” he said.

“Although the data cannot provide absolute proof of a causal relationship, it would seem prudent to ensure that strategies for managing the blood glucose concentration in critically ill patients focus not only on the control of hyperglycemia (high blood glucose concentration), but also on avoidance of both moderate and severe hypoglycemia.”

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