NICE-SUGAR Brief Summary – Intensive insulin therapy in the MICU/SICU

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Summary of the NICE-SUGAR Trial

Among critically ill patients, intensive glucose control increased 90-day mortality and the incidence of severe hypoglycemia compared to conventional therapy.

Key Points from NICE-SUGAR

  • Included 6104 medical/surgical patients with an anticipated ICU length of stay > 3 days
  • Randomized patients to intensive control (BG 81-108 mg/dL) vs. conventional control (<180 mg/dL)
  • Primary outcome (90-day mortality) was more common with intensive control (27.5% vs. 24.9%, p=0.02, NNH 38) and was primarily driven by cardiovascular causes
  • Subgroup analysis of primary endpoint showed possible benefit with intensive control with trauma (OR 0.77, 95% CI 0.5-1.18, p=0.07) and with corticosteroids at baseline (OR 0.88, 95% CI 0.66-1.19, p=0.06)
  • No difference in 28-day mortality (22.3% vs. 20.8%, p=0.17)
  • Mean morning BG values were 118 mg/dL (intensive) vs. 145 mg/dL (conventional)
  • More patients in the intensive group received corticosteroids (34.6% vs. 31.7%, p=0.02). The significance of this finding is very controversial
  • Severe hypoglycemia (BG < 40 mg/dL) occurred more with intensive control (6.8% vs. 0.5%, p<0.001, NNH 16)
  • There were no differences in morbidity outcomes, such as length of stay, duration of mechanical ventilation, need for renal replacement therapy, or infections
  • Two major differences in comparison to the Leuven trials (van den Berghe et al) are that NICE-SUGAR was multi-center and used less parenteral nutrition — both of which increase external validity


NICE-SUGAR Study Investigators, Finfer S, Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009 Mar 26;360(13):1283-97. PMID 19318384

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