• Julien Bohé, Hassane Abidi, Vincent Brunot, Amna Klich, Kada Klouche, Nicholas Sedillot, Xavier Tchenio, QuenotJean-PierreJPService de Médecine Intensive Réanimation, CHU Dijon Bourgogne, Dijon, France.INSERM, U1231, Equipe Lipness and 4 LipSTIC LabEx, Fondation de coopération scientifique Bourgogne-Franche-Comté, Dijon, France.NSERM, CIC 1432, Module Epidém, Jean-Baptiste Roudaut, Nicolas Mottard, Fabrice Thiollière, Jean Dellamonica, Florent Wallet, Bertrand Souweine, Alexandre Lautrette, Jean-Charles Preiser, Jean-François Timsit, Charles-Hervé Vacheron, Ait HssainAliAService de Médecine Intensive Réanimation, CHU Hôpital Gabriel-Montpied, Clermont-Ferrand, France., Delphine Maucort-Boulch, and CONTROLe INdividualisé de la Glycémie (CONTROLING) Study Group.
• Service d'Anesthésie-Réanimation-Médecine intensive, Groupement hospitalier sud, Hospices Civils de Lyon, 165 Chemin du grand Revoyet, 69310, Pierre Bénite, France. julien.bohe@chu-lyon.fr.
• Intensive Care Med. 2021 Nov 1; 47 (11): 1271-1283.

PurposeHyperglycaemia is an adaptive response to stress commonly observed in critical illness. Its management remains debated in the intensive care unit (ICU). Individualising hyperglycaemia management, by targeting the patient's pre-admission usual glycaemia, could improve outcome.MethodsIn a multicentre, randomized, double-blind, parallel-group study, critically-ill adults were considered for inclusion. Patients underwent until ICU discharge either individualised glucose control by targeting the pre-admission usual glycaemia using the glycated haemoglobin A1c level at ICU admission (IC group), or conventional glucose control by maintaining glycaemia below 180 mg/dL (CC group). A non-commercial web application of a dynamic sliding-scale insulin protocol gave to nurses all instructions for glucose control in both groups. The primary outcome was death within 90 days.ResultsOwing to a low likelihood of benefit and evidence of the possibility of harm related to hypoglycaemia, the study was stopped early. 2075 patients were randomized; 1917 received the intervention, 942 in the IC group and 975 in the CC group. Although both groups showed significant differences in terms of glycaemic control, survival probability at 90-day was not significantly different (IC group: 67.2%, 95% CI [64.2%; 70.3%]; CC group: 69.6%, 95% CI [66.7%; 72.5%]). Severe hypoglycaemia (below 40 mg/dL) occurred in 3.9% of patients in the IC group and in 2.5% of patients in the CC group (p = 0.09). A post hoc analysis showed for non-diabetic patients a higher risk of 90-day mortality in the IC group compared to the CC group (HR 1.3, 95% CI [1.05; 1.59], p = 0.018).ConclusionTargeting an ICU patient's pre-admission usual glycaemia using a dynamic sliding-scale insulin protocol did not demonstrate a survival benefit compared to maintaining glycaemia below 180 mg/dL.© 2021. The Author(s).

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