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Title: A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: The Glucontrol study
Authors: Preiser, Jean Charles
Devos, Philippe
Ruiz-Santana, Sergio 
Mélot, Christian
Annane, Djillali
Groeneveld, Johan
Iapichino, Gaetano
Leverve, Xavier
Nitenberg, Gérard
Singer, Pierre
Wernerman, Jan
Joannidis, Michael
Stecher, Adela
Chioléro, René
UNESCO Clasification: 32 Ciencias médicas
3201 Ciencias clínicas
Keywords: Critically-Ill Patients
Hospital Mortality
Infusion Protocol
Implementation, et al
Issue Date: 2009
Journal: Intensive Care Medicine 
Abstract: An optimal target for glucose control in ICU patients remains unclear. This prospective randomized controlled trial compared the effects on ICU mortality of intensive insulin therapy (IIT) with an intermediate glucose control.Adult patients admitted to the 21 participating medico-surgical ICUs were randomized to group 1 (target BG 7.8-10.0 mmol/L) or to group 2 (target BG 4.4-6.1 mmol/L).While the required sample size was 1,750 per group, the trial was stopped early due to a high rate of unintended protocol violations. From 1,101 admissions, the outcomes of 542 patients assigned to group 1 and 536 of group 2 were analysed. The groups were well balanced. BG levels averaged in group 1 8.0 mmol/L (IQR 7.1-9.0) (median of all values) and 7.7 mmol/L (IQR 6.7-8.8) (median of morning BG) versus 6.5 mmol/L (IQR 6.0-7.2) and 6.1 mmol/L (IQR 5.5-6.8) for group 2 (p < 0.0001 for both comparisons). The percentage of patients treated with insulin averaged 66.2 and 96.3%, respectively. Proportion of time spent in target BG was similar, averaging 39.5% and 45.1% (median (IQR) 34.3 (18.5-50.0) and 39.3 (26.2-53.6)%) in the groups 1 and 2, respectively. The rate of hypoglycaemia was higher in the group 2 (8.7%) than in group 1 (2.7%, p < 0.0001). ICU mortality was similar in the two groups (15.3 vs. 17.2%).In this prematurely stopped and therefore underpowered study, there was a lack of clinical benefit of intensive insulin therapy (target 4.4-6.1 mmol/L), associated with an increased incidence of hypoglycaemia, as compared to a 7.8-10.0 mmol/L target.
ISSN: 0342-4642
DOI: 10.1007/s00134-009-1585-2
Source: Intensive Care Medicine [ISSN 0342-4642], v. 35, p. 1738-1748
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