Study to change how critically ill patients are treated

Intensive blood glucose lowering has been embraced to control hyperglycemia.

Australian and New Zealand clinicians, uncertain if intensively lowering blood glucose was harmful or beneficial to critically ill patients have found it increases the risk of dying by 10 per cent.

Results of the largest trial of intensive blood glucose lowering in intensive care patients indicate that international clinical practice and guidelines need urgent review.

Internationally, intensive blood glucose lowering has been widely recommended and embraced to control hyperglycemia which is common among acutely ill patients and linked with serious complications such as organ failure and death.

Local researchers were concerned with this treatment strategy and decided to conduct a large trial to confirm the best treatment for critically ill patients. These new findings reveal that international practice to intensively lower blood glucose actually increases the risk of death among ICU patients.

“Intensively lowering blood glucose in critically ill patients is not beneficial and may be harmful.

Based on our findings, we do not recommend pursuing a normal blood glucose level in critically ill patients,” says chief investigator, Professor Simon Finfer from the University of Sydney’s George Institute for International Health.

Researchers from The Australian and New Zealand Intensive Care Society Clinical Trials Group,

The George Institute for International Health, The Canadian Critical Care Trials Group and Vancouver Coastal Health Research Institute set out to clarify the target range for blood glucose levels in critically ill patients.

They followed 6104 ICU patients in Australia, New Zealand, Canada and the USA for up to 90 days to assess whether the treatment would improve patients chance of survival.

“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. This new study gives us more powerful information, based on this larger study with stronger evidence, we can conclude that targeting very low levels of blood glucose is not safe,” says Professor John Myburgh from the George Institute for International Health.

In Australia over 125,000 people are admitted to ICUs each year and around 7500 patients die in Australian ICUs each year. The new evidence suggests that current guidelines must be reviewed.

The study, NICE-SUGAR (Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation) randomly assigned patients to one of two target ranges for blood glucose; an intensive control target (81-108mg/dL; 4.5-6.0 mmol/L) or a conventional control target (180mg/dL; 10.0 mmol/L or less).

Control of blood glucose was achieved by the use of an intravenous infusion of insulin.

ICU Statistics – number of people admitted to intensive care each year
ACT: over 2000
NSW: over 40,000
NT: over 1200
QLD: over 25,000
SA: over 13,000
TAS: over 1500
VIC: over 28,000
WA: over 7000

Top 5 diagnosis for ICU admittance in adults during 2007
1. Heart surgery/ artery bypass
2. Gastro Intestinal cancer and tumours
3. Valvular heart surgery
4. Drug overdose
5. Bacterial pneumonia

Top 5 diagnosis for PICU admittance in children during 2007
1. Bronchiolitis
2. Seizures
3. Asthma
4. Respiratory failure
5. Head trauma

Source: Intensive Care Foundation

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