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“Intensively lowering blood glucose in critically ill patients is not beneficial and may be harmful,” said Dr. Simon Finfer, a senior staff specialist in intensive care at Royal North Shore Hospital in Sydney, Australia, and lead author of the study. “Based on our findings, we do not recommend pursuing a normal blood glucose level in critically ill patients.”
AACE warned against “letting this study swing the pendulum of glucose control too far in the other direction, where providers in hospitals are complacent about uncontrolled hyperglycemia.”
“We found that intensively lowering blood glucose levels increased a patient’s risk of dying by 10 percent,” Finfer said.
“International guidelines should be revised to reflect this new evidence,” he said. “Many professional organizations recommend very tight glucose control for ICU patients. They will now need to take this new evidence into consideration and adjust their recommendations accordingly.”
“Complete recommendations from the panel will be published in Endocrine Practice and Diabetes Care later in the spring,” according to the ADA/AACE statement. “Until more information is available, it seems reasonable for clinicians to treat critical care patients with the less intensive — yet good — glucose control strategies used in the conventional arm [of the study].”
“Get the sugars down, but keeping them in the slightly elevated range, is probably not a bad thing, at least during the short course of most hospitalizations,” he said. “Medicine is always changing as new evidence emerges. We need to incorporate new findings into our practice patterns.”