Glucose Control in the ICU — How Tight Is Too Tight?

For the past decade, hospitals have focused on the inpatient management of hyperglycemia, particularly in the intensive care unit (ICU). Extensive observational data have shown a consistent, almost linear relationship between blood glucose levels in hospitalized patients and adverse clinical outcomes, even in patients without established diabetes.1 It has never been entirely clear, however, whether glycemia serves as a mediator of these outcomes or merely as a marker of the sickest patients, who present with the well-known counterregulatory stress response to illness. Several early studies suggested a clinical benefit from strict glucose control during critical care but were weakened by . . .