Contact: Arlyn G. Riskind
Director, Media Relations
Phone: (301) 941-0240
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Contact: Aaron Lohr
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Phone: (240) 482-1380
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The Endocrine Society Suggests Tailored Approach to Glycemic Control in Response to the NICE-SUGAR Study Published this Week in the New England Journal of Medicine

 
The Society’s full statement can be accessed here.

Chevy Chase, MD— The Endocrine Society commends the NICE-SUGAR investigators for producing an important and provocative addition to the medical literature. This new study, published online this week in the New England Journal of Medicine (NEJM), suggests that intensive blood glucose (sugar) control for patients with hyperglycemia (high blood sugar) receiving critical care does not improve outcomes and is associated with an increase in deaths.

The findings of the Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation (NICE-SUGAR) Study specifically suggest that near-normalization of blood sugar does not clearly improve outcomes in all critically ill hyperglycemic ICU patients, and there is even a suggestion that such an approach may worsen outcomes, possibly leading to death.

Based on this counterintuitive finding it appears that looser control of hyperglycemia (blood glucose values of 144-180 mg/dl as defined in the study) may be a reasonable and perhaps preferable option in caring for this group of very sick patients.  

The Society therefore believes that the rush to deploy difficult and resource-intensive protocols in ICU’s may be premature until there is a better understanding of the reasons why the NICE-SUGAR results differ so markedly from an earlier study by Van den Berghe et al.  In her study, Van den Berghe found that tight control of blood sugar in critically ill hyperglycemic patients seemed to improve outcomes.  These results however, could not be replicated in a subsequent study.

Although these two studies differ in design and target patient populations, the fact that they have what appears to be opposite outcomes, suggest the need for further studies.

The Endocrine Society believes that we have entered an era of more nuanced and patient-appropriate recommendations as a result of these recent large, well-done outpatient and inpatient studies.  Until there is greater insight into these demonstrated and counterintuitive findings, the Society suggests that physicians should individually tailor their approach to glycemic control in their ICU patients by targeting glucose values between 144-180 mg/dl.

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Founded in 1916, The Endocrine Society is the world's oldest, largest, and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, The Endocrine Society's membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Md. To learn more about the Society, and the field of endocrinology, visit our web site at www.endo-society.org.