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Intensive versus Conventional Glucose Control in Critically Ill Patients

Finfer, Simon; Chittock, Dean; Yu Shuo Su, Steve; Blair, Deborah; Foster, Denise; Dhingra, V; Bellomo, Rinaldo; Cook, Deborah; Dodek, Peter; Henderson, Daren; Hebert, Paul; Heritier, Stephane; Heyland, Daren; McArthur, Colin; McDonald, Ellen; Mitchell, Imogen; Myburgh, John; Norton, Robyn; Potter, Julie; Robinson, Bruce; Ronco, Juan J

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Background The optimal target range for blood glucose in critically ill patients remains unclear. Methods Within 24 hours after admission to an intensive care unit(ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter(4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per...[Show more]

dc.contributor.authorFinfer, Simon
dc.contributor.authorChittock, Dean
dc.contributor.authorYu Shuo Su, Steve
dc.contributor.authorBlair, Deborah
dc.contributor.authorFoster, Denise
dc.contributor.authorDhingra, V
dc.contributor.authorBellomo, Rinaldo
dc.contributor.authorCook, Deborah
dc.contributor.authorDodek, Peter
dc.contributor.authorHenderson, Daren
dc.contributor.authorHebert, Paul
dc.contributor.authorHeritier, Stephane
dc.contributor.authorHeyland, Daren
dc.contributor.authorMcArthur, Colin
dc.contributor.authorMcDonald, Ellen
dc.contributor.authorMitchell, Imogen
dc.contributor.authorMyburgh, John
dc.contributor.authorNorton, Robyn
dc.contributor.authorPotter, Julie
dc.contributor.authorRobinson, Bruce
dc.contributor.authorRonco, Juan J
dc.date.accessioned2015-12-07T22:31:20Z
dc.identifier.issn0028-4793
dc.identifier.urihttp://hdl.handle.net/1885/22735
dc.description.abstractBackground The optimal target range for blood glucose in critically ill patients remains unclear. Methods Within 24 hours after admission to an intensive care unit(ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter(4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per deciliter(10.0 mmol or less per liter). We defined the primary end point as death from any cause within 90 days after randomization. Results Of the 6104 patients who underwent randomization, 3054 were assigned to undergo intensive control and 3050 to undergo conventional control; data with regard to the primary outcome at day 90 were available for 3010 and 3012 patients, respectively. The two groups had similar characteristics at baseline. A total of 829 patients(27.5%) in the intensive-control group and 751(24.9%) in the conventional-control group died(odds ratio for intensive control, 1.14; 95% confidence interval, 1.02 to 1.28; P=0.02). The treatment effect did not differ significantly between operative(surgical) patients and nonoperative(medical) patients(odds ratio for death in the intensive-control group, 1.31 and 1.07, respectively; P = 0.10). Severe hypoglycemia(blood glucose level, <40 mg per deciliter [2.2 mmol per liter]) was reported in 206 of 3016 patients(6.8%) in the intensive-control group and 15 of 3014(0.5%) in the conventional-control group(P<0.001). There was no significant difference between the two treatment groups in the median number of days in the ICU(P = 0.84) or hospital(P = 0.86) or the median number of days of mechanical ventilation(P = 0.56) or renal-replacement therapy(P=0.39). Conclusions In this large, international, randomized trial, we found that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg or less per deciliter resulted in lower mortality than did a target of 81 to 108 mg per deciliter.(ClinicalTrials.gov number, NCT00220987.)
dc.publisherMassachusetts Medical Society
dc.sourceNew England Journal of Medicine
dc.subjectKeywords: antidiabetic agent; corticosteroid; insulin; glucose; article; chemically induced disorder; clinical trial; comparative study; controlled clinical trial; controlled study; critical illness; female; glucose blood level; human; hyperglycemia; hypoglycemia;
dc.titleIntensive versus Conventional Glucose Control in Critically Ill Patients
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume360
dc.date.issued2009
local.identifier.absfor110310 - Intensive Care
local.identifier.ariespublicationu4201517xPUB23
local.type.statusPublished Version
local.contributor.affiliationFinfer, Simon, The Canberra Hospital
local.contributor.affiliationChittock, Dean, Vancouver General Hospital
local.contributor.affiliationYu Shuo Su, Steve, Queensland University of Technology
local.contributor.affiliationBlair, Deborah, Western Massachusetts Kidney Center
local.contributor.affiliationFoster, Denise, SUGAR (North American) Management Committee
local.contributor.affiliationDhingra, V, SUGAR (North American) Management Committee
local.contributor.affiliationBellomo, Rinaldo, The Canberra Hospital
local.contributor.affiliationCook, Deborah, SUGAR (North American) Management Committee
local.contributor.affiliationDodek, Peter, SUGAR (North American) Management Committee
local.contributor.affiliationHenderson, Daren, SUGAR (North American) Management Committee
local.contributor.affiliationHebert, Paul, SUGAR (North American) Management Committee
local.contributor.affiliationHeritier, Stephane, University of Sydney
local.contributor.affiliationHeyland, Daren, SUGAR (North American) Management Committee
local.contributor.affiliationMcArthur, Colin, Auckland City Hospital
local.contributor.affiliationMcDonald, Ellen, SUGAR (North American) Management Committee
local.contributor.affiliationMitchell, Imogen, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationMyburgh, John, University of Sydney
local.contributor.affiliationNorton, Robyn, University of Sydney
local.contributor.affiliationPotter, Julie, Royal North Shore Hospital
local.contributor.affiliationRobinson, Bruce, University of Sydney
local.contributor.affiliationRonco, Juan J, University of British Columbia
local.description.embargo2037-12-31
local.bibliographicCitation.issue13
local.bibliographicCitation.startpage1283
local.bibliographicCitation.lastpage1297
local.identifier.doi10.1056/NEJMoa0810625
dc.date.updated2016-02-24T10:41:37Z
local.identifier.scopusID2-s2.0-63249128249
CollectionsANU Research Publications

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