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To the Editor: Dr Soylemez Wiener and colleagues¹ reported the results of a meta-analysis that included 29 studies on tight glucose control in critically ill adults. Several methodological issues limit the conclusions to be drawn from this study.

First, the included studies have substantial differences, most importantly concerning the type of intervention (fixed vs titrated insulin dose) and the glucose levels actually achieved. The proof-of-concept study on tight glucose control in the intensive care unit (ICU)² hypothesized that normalization of blood glucose (80-110 mg/dL) with insulin protects against complications (eg, severe infections, organ failure, death). (To convert glucose values to mmol/L, multiply by 0.0555.) The scientific concept was that any degree of hyperglycemia above normal (110 mg/dL) in a condition of ischemia/reperfusion additionally damages those cells that take up glucose passively. The study by Soylemez Wiener et al pooled all published studies on insulin therapy (including glucose-insulin-potassium) and those . . . [Full Text of this Article]

Greet Hermans, MD
Department of General Internal Medicine

Miet Schetz, MD, PhD; Greet van den Berghe, MD, PhD
greet.vandenberghe@med.kuleuven.be
Department of Intensive Care Medicine
Catholic University of Leuven
Leuven, Belgium

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