title: Tight computerized versus conventional glucose control in the ICU: a randomized controlled trial.
abstract: OBJECTIVE
  The blood glucose target range and optimal method to reach this range remain a matter of debate in the intensive care unit (ICU). A computer decision support system (CDSS) might improve the outcome of ICU patients through facilitation of a tighter blood glucose control.
  
  
  METHODS
  We conducted a multi-center randomized trial in 34 French ICU. Adult patients expected to require treatment in the ICU for at least 3 days were randomly assigned without blinding to undergo tight computerized glucose control with the CDSS (TGC) or conventional glucose control (CGC), with blood glucose targets of 4.4-6.1 and <10.0 mmol/L, respectively. The primary outcome was all-cause death within 90 days after ICU admission.
  
  
  RESULTS
  Of the 2,684 patients who underwent randomization to the TGC and CGC treatment groups, primary outcome was available for 1,335 and 1,311 patients, respectively. The baseline characteristics of these treatment groups were similar in terms of age (61 ± 16 years), SAPS II (51 ± 19), percentage of surgical admissions (40.0%) and proportion of diabetic patients (20.3%). A total of 431 (32.3%) patients in the TGC group and 447 (34.1%) in the CGC group had died by day 90 (odds ratio for death in the TGC 0.92; 95% confidence interval 0.78-1.78; p = 0.32). Severe hypoglycemia (<2.2 mmol/L) occurred in 174 of 1,317 patients (13.2%) in the TGC group and 79 of 1,284 patients (6.2%) in the CGC group (p < 0.001).
  
  
  CONCLUSIONS
  Tight computerized glucose control with the CDSS did not significantly change 90-day mortality and was associated with more frequent severe hypoglycemia episodes in comparison with conventional glucose control.
authors.affiliation: Service de Réanimation polyvalente, Hôpital Louis Pasteur, Hôpitaux de Chartres, Chartres Cedex, 28018, Le Coudray, France. pkalfon@ch-chartres.fr.|UMR INSERM 956, Université Pierre et Marie Curie, Paris, France. pkalfon@ch-chartres.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Kalfon
authors.affiliation: INSERM CIC (Centre d'investigation clinique) 202, Centre Hospitalier Universitaire (CHU) de Tours, Tours, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Giraudeau
authors.affiliation: Service de Réanimation médico-chirurgicale, Hôpital Saint-Roch, CHU de Nice, Nice, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Ichai
authors.affiliation: LK2, Saint-Avertin, France.|Institut National de Recherche en Informatique et en Automatique (INRIA), Rocquencourt, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Guerrini
authors.affiliation: Service de Réanimation médicale, Institut de Cardiologie, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Brechot
authors.affiliation: Service de Réanimation chirurgicale cardio-thoracique et vasculaire, Hôpital Laennec, CHU de Nantes, Nantes, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Cinotti
authors.affiliation: Service de Réanimation médicale, Hôpital Bretonneau, CHRU de Tours, Tours, France.
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Dequin
authors.affiliation: Service de Réanimation polyvalente, Hôpital Purpan, CHU de Toulouse, Toulouse, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Riu-Poulenc
authors.affiliation: Département d'Anesthésie et Réanimation chirurgicale, CHU Bichat-Claude Bernard, AP-HP, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Montravers
authors.affiliation: Service de Réanimation, CHU Raymond Poincaré, AP-HP, Garches, France.
authors.forename: Djilalli
authors.initials: D
authors.lastname: Annane
authors.affiliation: Service d'Anesthésie Réanimation, Hôpital Nord, CHRU Amiens, Amiens, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
authors.affiliation: Institut National de Recherche en Informatique et en Automatique (INRIA), Rocquencourt, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Sorine
authors.affiliation: UMR INSERM 956, Université Pierre et Marie Curie, Paris, France.|Service d'accueil des Urgences, CHU Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Riou
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D003422:Critical Care / Q000379:methods*; D004360:Drug Therapy, Computer-Assisted; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin