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NICE-SUGAR was a large randomised trial that compared intensive glucose control with conventional glucose management in more than 6,000 critically ill adults. The intensive strategy targeted blood glucose levels around 81–108 mg/dL, whereas the conventional strategy aimed for 180 mg/dL or less. The trial found higher 90-day mortality with intensive glucose control, establishing that tighter glycaemic targets could cause harm rather than benefit. Hypoglycaemia was also substantially more frequent in the intensive-treatment group. The study changed practice because it demonstrated the importance of separating biologic plausibility from clinical outcomes. Earlier studies had suggested that normalising glucose might protect critically ill patients, but NICE-SUGAR showed that aggressive insulin treatment carries its own risks and does not translate into improved survival. For bedside care, the practical implication is to avoid extremes: uncontrolled hyperglycaemia is undesirable, but pursuing near-normal glucose with intensive insulin therapy can create dangerous hypoglycaemia and treatment burden. The trial remains foundational when interpreting newer studies of metabolic management, nutrition and insulin protocols. It also illustrates a recurring ICU lesson: targets that look attractive in isolation should be tested against patient-centred outcomes before becoming routine standards.
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NICE-SUGAR was a large randomised trial that compared intensive glucose control with conventional glucose management in more than 6,000 critically ill adults. The intensive strategy targeted blood glucose levels around 81–108 mg/dL, whereas the conventional strategy aimed for 180 mg/dL or less. The trial found higher 90-day mortality with intensive glucose control, establishing that tighter glycaemic targets could cause harm rather than benefit. Hypoglycaemia was also substantially more frequent in the intensive-treatment group. The study changed practice because it demonstrated the importance of separating biologic plausibility from clinical outcomes. Earlier studies had suggested that normalising glucose might protect critically ill patients, but NICE-SUGAR showed that aggressive insulin treatment carries its own risks and does not translate into improved survival. For bedside care, the practical implication is to avoid extremes: uncontrolled hyperglycaemia is undesirable, but pursuing near-normal glucose with intensive insulin therapy can create dangerous hypoglycaemia and treatment burden. The trial remains foundational when interpreting newer studies of metabolic management, nutrition and insulin protocols. It also illustrates a recurring ICU lesson: targets that look attractive in isolation should be tested against patient-centred outcomes before becoming routine standards.
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