Blood glucose control in the ICU: how tight?

Fifteen years after the first randomized controlled trial (RCT) on tight blood glucose control (TGC) in the intensive care unit (ICU), the exact target of blood glucose control remains a matter of debate, especially since subsequent RCTs have found divergent results (1-4). Indeed, whereas the Leuven RCTs found that targeting normal for age fasting blood glucose levels with insulin clearly reduced short-term morbidity and mortality in critically ill adults and children (1-3), with the benefit maintained on the long term (5,6), the largest multicenter RCT (NICE-SUGAR) found excess mortality (4), which was attributed to an increased risk of severe hypoglycemia (7).