Tight Blood Sugar Control May Raise Risks in the ICU

Mar. 25 -- TUESDAY, March 24 (HealthDay News) -- People hospitalized in intensive care units, or ICUs, often experience spikes in blood sugar, and current practice is to try to lower these levels.

But a new study found that this strategy might actually boost the person's relative risk of death by 10 percent.

"Intensively lowering blood glucose in critically ill patients is not beneficial and may be harmful," said Dr. Simon Finfer, a senior staff specialist in intensive care at Royal North Shore Hospital in Sydney, Australia, and lead author of the study. "Based on our findings, we do not recommend pursuing a normal blood glucose level in critically ill patients."

Expert groups remain cautious about the study's findings, however. In a joint statement issued March 24, the American Diabetic Association (ADA) and the American Association of Clinical Endocrinologists (AACE) warned against "letting this study swing the pendulum of glucose control too far in the other direction, where providers in hospitals are complacent about uncontrolled hyperglycemia."

The study is published March 24 in the online edition of the New England Journal of Medicine to coincide with a presentation at the International Symposium on Intensive Care and Emergency Medicine in Brussels.

Intensive glucose lowering has been recommended to control high blood sugar, which is common in people who are acutely ill and has been associated with organ failure and death.

For the study, Finfer's team randomly assigned more than 6,100 ICU patients to either intensive or conventional blood sugar control. The researchers used infusions of insulin to achieve specific blood sugar levels. The participants were then followed for 90 days.

"We found that intensively lowering blood glucose levels increased a patient's risk of dying by 10 percent," Finfer said. Overall, 24.9 percent of those whose blood sugar was controlled by conventional means died within 90 days compared with 27.5 percent of those who were given intensive infusions -- about a one-tenth rise. The percentage of people who experienced hypoglycemia, or low blood sugar, was also higher in the intensely treated group compared with the conventional care group.