Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE SUGAR)

Hyperglycaemia (high blood sugar) is a common finding in patients in the intensive care unit (ICU), whether or not the patient has a history of diabetes mellitus.

Internationally, intensive blood glucose lowering was widely recommended and embraced to control hyperglycemia (high blood sugar). Local researchers were concerned with this treatment strategy and decided to conduct a large, landmark trial to confirm the best treatment for critically ill patients.

Previous, smaller research studies have produced conflicting results and overall suggested that intensive blood glucose control didn’t affect death rates in critically ill adults.


The primary aim of the NICE-SUGAR study was to compare the effects of two blood glucose targets on 90-day all-cause mortality in intensive care patients.


The NICE-SUGAR study was a multi-centre, international, open label, randomised controlled trial of blood glucose management comparing two blood glucose targets. The study was a collaboration of The George Institute, The ANZICS Clinical Trials Group, The Canadian Critical Care Trials Group and Vancouver Coastal Health Research Institute.


In this study, 6100 patients were recruited in 42 Intensive Care Units throughout Australia, New Zealand, Canada and the USA. The treatment groups were assigned to one of two targets for blood glucose, either the lower range target of 4.5 - 6.0 mmol/L (81-108 mg/dl) or the higher range target of 8.0 - 10.0 mmol/L (144 - 180 mg/dl).


Recruitment commenced in April 2005 and was completed in August 2008. The results of this study showed that intensively lowering blood glucose in critically ill patients is not beneficial and may be harmful. It was shown that intensively lowering blood glucose levels increased a patient’s risk of dying by 10%.