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Tight Blood Sugar Control May Raise Risks in the ICU
Date:3/24/2009

percent," Finfer said. Overall, 24.9 percent of those whose blood sugar was controlled by conventional means died within 90 days compared with 27.5 percent of those who were given intensive infusions -- about a one-tenth rise. The percentage of people who experienced hypoglycemia, or low blood sugar, was also higher in the intensely treated group compared with the conventional care group.

The findings reveal that the current practice of intensively lowering blood glucose increases the risk of death among patients in the ICU, Finfer said.

"International guidelines should be revised to reflect this new evidence," he said. "Many professional organizations recommend very tight glucose control for ICU patients. They will now need to take this new evidence into consideration and adjust their recommendations accordingly."

Dr. Silvio E. Inzucchi, a professor of medicine at Yale University School of Medicine and author of an accompanying journal editorial, believes the findings might change clinical practice in the ICU.

The study "raises a big question mark about intensive blood sugar control in intensive care patients," Inzucchi said. "We used to think that keeping the sugar levels in the normal range was a good thing. This study says the opposite. The truth is probably somewhere in the middle.

Sugar control "should be good in the hospital," he said. "It just need not be super tight."

For their part, the ADA and AACE stress that doctors must still closely monitor and manage the blood sugar levels of very ill patients.

The findings "should not lead to an abandonment of the concept of good glucose management in the hospital setting," the groups said in their joint statement. They also pointed out that the study compared outcomes for patients receiving either very strict glucose control or, in the conventional treatment arm, less strict but still well-controlled blood sugar management.

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