als.11,13 The Normoglycemia in Intensive Care Evaluation — Survival Using Glucose Algorithm Regulation (NICE-SUGAR)

Hyperglycemia is associated with adverse outcomes, in-cluding increased mortality, in acutely ill patients.1–7 In2001, a randomized trial involving patients admitted to a surgical intensive care unit (ICU) showed that intensive in-sulin therapy, targeting a blood glucose concentration of 4.4–6.1 mmol/L, significantly reduced in-hospital mortality.8 Subse-quent trials have failed to confirm a mortality benefit with inten-sive insulin therapy among critically ill patients, in whom stress hyperglycemia is common.9–13 A recent meta-analysis concluded that such therapy did not reduce mortality among critically ill patients.14 Despite conflicting evidence, intensive insulin therapy has been recommended as the standard of care for critically ill patients by the American Diabetes Association,15 the American Association of Clinical Endocrinologists16 and other profes-sional organizations.17 A consistent finding in trials of such ther-apy has been an increased risk of severe hypoglycemia, which was the impetus for early termination of 2 large European tri