Wiener RS et al. (2008) Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA 300: 933–944

Tight glycemic control has been shown to reduce mortality in critically ill, surgical patients and is now widely recommended for all critically ill adults. However, a growing body of evidence suggests that in these patients such control might increase the risk of hypoglycemic events and even mortality, which prompted Wiener et al. to conduct a meta-analysis to assess the risks and benefits of tight glycemic control versus normal care in critically ill adults.

The authors searched MEDLINE (1950–2008), the Cochrane Library, multiple trial registries, reference lists and abstracts from selected medical conferences, and identified 29 relevant, randomized, controlled trials for inclusion. In analyses of pooled data, tight glycemic control was not associated with significant reductions in hospital mortality or need for dialysis, either overall or in subgroups stratified by intensive-care setting (i.e. surgical, medical, or all critically ill patients) or glycemia target—very tight (≤6.1 mmol/l) or moderately tight control (<8.3 mmol/l). The risk of hypoglycemic events (glucose ≤2.2 mmol/l) was increased in patients receiving tight glycemic control; this risk was particularly high for the subgroup receiving very tight control. By contrast, the tight-control group had a decreased risk of septicemia, although this decrease was limited to critically ill, surgical patients.

The findings refute a mortality benefit of tight glycemic control in critically ill adults and highlight the need to re-evaluate this recommendation.