The NICE-SUGAR trial demonstrated that in critically ill ICU patients, intensive insulin therapy targeting glucose 4.5–6.0 mmol/L compared to conventional control (≤10 mmol/L) led to:
- A Increased 90-day mortality primarily due to severe hypoglycaemia ✓
- B Reduced 90-day mortality and fewer infections
- C Equivalent mortality but fewer ventilator days
- D Reduced mortality only in surgical ICU patients
Correct answer: A. Increased 90-day mortality primarily due to severe hypoglycaemia
Explanation
NICE-SUGAR (2009) showed intensive glucose control (4.5–6.0 mmol/L) significantly increased 90-day all-cause mortality (27.5% vs 24.9%) compared to conventional control (≤10 mmol/L) in a mixed medical-surgical ICU population. The excess mortality was attributed to severe hypoglycaemia episodes (6.8% vs 0.5%), which caused cardiac arrhythmias and CNS injury. This landmark trial reversed the practice of tight glycaemic control and established the current target of ≤10 mmol/L (180 mg/dL).
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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