Resumen del Nice-Sugar stady que va a ser publicado la semana que viene en el NEJM.
Este estudio junto con otro recientemente publicado en el Crit Care Med 2008; 36:3190–3197, hacen que ya no se pueda recomendar el objetiovo previo de 80-110 mg de UCIs y las sociedades científicas como la ADA van a cambiar sus recoemndaciones en un futuro cercano,
Intensive versus Conventional Glucose Control in Critically Ill Patients:
The NICE-SUGAR Study
N Engl J Med 2009;360:1283-97
Methods:
6104 ICU patients were randomized to (3054) intensive BG control (81 to 108 mg/dl) and (3050) to conventional control (BG <>
Primary end point: death from any cause within 90 days after randomization.
Results:
829 patients (27.5%) in the intensive-control group and 751 (24.9%) in the conventional-control group died (OR for intensive control, 1.14; 95% CI, 1.02 to 1.28; P = 0.02).
The treatment effect did not differ significantly between surgical and medical patients (OR for death in the intensive-control group, 1.31 and 1.07, respectively; P = 0.10).
Severe hypoglycemia (BG ≤40 mg/dl was reported in 6.8% in the intensive-control group and 0.5% in the conventional-control group (P<0.001).
No significant difference between 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, 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/dl
