The detrimental effects of hyperglycemia in critically ill patients has been well described in the literature. However, the benfefits of maintaining normoglycemia using insulin infusions has been controversial. In 2009, The New England Journal of Medicine published a study by the NICE-SUGAR Study Investigators that appeared to answer the question about risks and benefits of intensive insulin therapy. Studying more than 6,000 subjects, the authors showed an increase in mortality in critically ill adults who underwent intensive glucose control, compared to those who underwent conventional control of their blood sugars. Interestingly, in the same year, a pediatric study was published in Lancet by Vlasselaers et al that demonstrated a decrease in mortality and length of pediatric intensive care unit (PICU) stay in those patients who had intensive glucose control, compared to the conventional therapy. Though it should be noted that while this study randomized 700 children, it was a single-center trial whose subjects were primarily children who had undergone cardiac surgery (around 75%).
In this study by Macrae et al, the authors randomized more than 1,300 critically ill children from 13 centers to undergo either tight glucose control (maintaining blood glucose levels between 72-126 mg/dl) or conventional therapy (infusing insulin only in patients whose blood glucose levels were over 216 mg/dl until they dropped to 180 mg/dl). The authors recruited children between the ages of 36 weeks of corrected gestational age and 16 years of age. Like the the Vlasselaers study, a predominance of subjects underwent cardiac surgery compared to other reasons for PICU admission (around 60% and 40%, respectivley). The aims of this study were to assess whether tight glycemic control could reduce morbidity and mortality rates and associated costs for critically ill children compared to conventional therapy.