, Volume 36, Issue 1, pp 173-174,
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Date: 24 Sep 2009

Glucontrol, no control, or out of control?

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Sir: Preiser et al. [1] are to be congratulated on their randomized controlled multi-center trial on tight glycemic control (TGC) in critically ill patients. This trial adds to our knowledge of glucose control in intensive care units, but also poses a fascinating dilemma. While we need confirmation of the effects of TGC observed in Leuven, we notice at the same time that the Leuven trials have already changed the standard of care against which we compare TGC.

First, from this trial we learn that the intensive care community is increasingly practicing (some sort of) glycemic control. Undeniably, all randomized controlled trials focusing on TGC [27], including this new trial [1], show a change in standard care: “control” or “conventional therapy” patients are more and more treated with insulin and consequently have lower (mean or median) blood glucose levels (Fig. 1). This at least suggests that the intensive care community is realizing that glucose should not be seen as an innocent byst ...

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