To the Editor: Recently published trials1,2 of tight glycemic control in critically ill patients have documented lack of treatment benefit and frequent severe hypoglycemia. The NICE-SUGAR trial raised the question of potential treatment-related harm and also documented significant hypoglycemia.3 The COIITSS Study4 evaluated intensive insulin therapy in critically ill patients with sepsis who were treated with glucocorticoids and reported a high incidence of hypoglycemia (16.4% vs 7.8% in the conventional treatment group) without apparent benefit. These large complex multicenter trials that evaluated insulin therapy during critical illness consistently demonstrated high rates of hypoglycemia with tight insulin therapy. However, they did not investigate the possibility of identifying patient subpopulations at increased risk for treatment-related hypoglycemia.
Castellanos MR, Rothman J, Kleiner M. Tight Glycemic Control in Critically Ill Patients. JAMA. 2010;303(17):1694-1695. doi:10.1001/jama.2010.515