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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. Figure 2 Data on Blood Glucose Level, According to Treatment Group. Panel A shows mean blood glucose levels. Baseline data are the averages of the last blood glucose measurement obtained before randomization; day 1 data are the average levels from the time of randomization to the end of the day of randomization. The bars indicate the 95% confidence intervals. The dashed line indicates 108 mg per deciliter, the upper limit of the target range for intensive glucose control.

686 Ami Bios Drivers Ethernet. Panel B shows the density plot for the mean time-weighted blood glucose levels for individual patients. The dashed lines indicate the modes (most frequent values) in the intensive-control group (blue) and the conventional-control group (red), as well as the upper threshold for severe hypoglycemia (black). To convert the values for blood glucose to millimoles per liter, multiply by 0.05551. Hyperglycemia is common in acutely ill patients, including those treated in intensive care units (ICUs). The occurrence of hyperglycemia, in particular severe hyperglycemia, is associated with increased morbidity and mortality in a variety of groups of patients, but trials examining the effects of tighter glucose control have had conflicting results. Systematic reviews and meta-analyses have also led to differing conclusions. Nevertheless, many professional organizations recommend tight glucose control for patients treated in ICUs.

Barriers to widespread adoption of tight glucose control include the increased risk of severe hypoglycemia, concerns about the external validity of some studies, the difficulty in achieving normoglycemia in critically ill patients, and the increased resources that would be required. Because of these issues and uncertainty about the balance of risks and benefits, tight glucose control is used infrequently by some clinicians.