Hyperglycemia has long been observed amongst critically ill patients and associated with increased mortality and morbidity. Tight glycemic control (TGC) is the clinical practice of controlling blood glucose (BG) down to the "normal" 4.4-6.1 mmol/L range of a healthy adult, aiming to avoid any potential deleterious effects of hyperglycemia. The ground-breaking Leuven trials reported a mortality benefit of approximately 10% when using this technique, which led many to endorse its benefits. In stark contrast, the multi-center normoglycemia in intensive care evaluation-survival using glucose algorithm regulation (NICE-SUGAR) trial, not only failed to replicate this outcome, but showed TGC appeared to be harmful. This review attempts to re-analyze the current literature and suggests that hope for a benefit from TGC should not be so hastily abandoned. Inconsistencies in study design make a like-for-like comparison of the Leuven and NICE-SUGAR trials challenging. Inadequate measures preventing hypoglycemic events are likely to have contributed to the increased mortality observed in the NICE-SUGAR treatment group. New technologies, including predictive models, are being developed to improve the safety of TGC, primarily by minimizing hypoglycemia. Intensive Care Units which are unequipped in trained staff and monitoring capacity would be unwise to attempt TGC, especially considering its yet undefined benefit and the deleterious nature of hypoglycemia. International recommendations now advise clinicians to ensure critically ill patients maintain a BG of <10 mmol/L. Despite encouraging evidence, currently we can only speculate and remain optimistic that the benefit of TGC in clinical practice is sweeter than assumed.
A pilot study of the SPRINT protocol for tight glycemic control in critically Ill patients. Diabetes Technol Ther 2006;8:449-62.
Interface design and human factors considerations for model-based tight glycemic control in critical care. J Diabetes Sci Technol 2012;6:125-34.
Pilot study of the SPRINT glycemic control protocol in a Hungarian medical intensive care unit. J Diabetes Sci Technol 2012;6:1464-77.
What makes tight glycemic control tight? The impact of variability and nutrition in two clinical studies. J Diabetes Sci Technol 2010;4:284-98.
Stochastic modelling of insulin sensitivity and adaptive glycemic control for critical care. Comput Methods Programs Biomed 2008;89:141-52.
Pilot proof of concept clinical trials of Stochastic Targeted (STAR) glycemic control. Ann Intensive Care 2011;1:38.
Nurse workload in implementing a tight glycaemic control protocol in a UK hospital: A pilot time-in-motion study. Nurs Crit Care 2012;17:279-84.
Impact of early parenteral nutrition completing enteral nutrition in adult critically ill patients (EPaNIC trial): A study protocol and statistical analysis plan for a randomized controlled trial. Trials 2011;12:21.
Early versus late parenteral nutrition in critically ill adults. N Engl J Med 2011;365:506-17.