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To the Editor: The meta-analysis by Dr Soylemez Weiner and colleagues¹ suggested limited benefits, if any, of tight glucose control in critically ill adults and a 3- to 5-fold increased risk of hypoglycemia. The accompanying Editorial by Drs Finfer and Delaney² discussed the findings in relation to the study by van den Berghe et al,³ which demonstrated that tight glucose control reduced mortality by one-third in surgical ICU patients. The Editorial briefly mentioned the possibility of inaccurate bedside glucose testing. We suggest that this concern should be considered more carefully.

The original study by van den Berghe et al³ used a precise arterial blood gas instrument for glucose measurement and arterial blood samples. In contrast, a second study from van den Berghe et al,⁴ which did not show improved mortality for medical ICU patients, used a point-of-care glucose meter with, in some cases, capillary (skin puncture) blood samples. This approach, . . . [Full Text of this Article]

Mitchell G. Scott, PhD
mscott@labmed.wustl.edu
Division of Laboratory and Genomic Medicine
Department of Pathology and Immunology
Washington University School of Medicine
St Louis, Missouri

David E. Bruns, MD
Department of Pathology
University of Virginia Health System
Charlottesville

David B. Sacks, MD
Department of Pathology
Brigham and Women's Hospital
Boston, Massachusetts

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