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Archived Comments for: Experimental and clinical evidences for glucose control in intensive care: is infused glucose the key point for study interpretation?

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  1. Testing the hypothesis that glucose administration plus tight glucose control is beneficial has the potential to harm

    Simon Finfer, The George Institute for Global Health

    4 November 2014

    In their article Mazeraud and colleagues attempt to explain why tight glucose control was benefiical in the first Leuven trial and not in other trials. They conclude that an interventional study evaluating liberal and restrictive glucose intake during IIT is warranted to provide reliable evidence. While such a trial would provide evidence about the modifying effect of glucose administration on the effects of IIT, it would not provide any information to decide whether IIT was beneficial in the first place. As they note, the EPaNIC study compared two feeding strategies in patients treated with IIT and did not support the further use of the feeding strategy employed in the first Leuven trial. The trial which would be most interesting would be one in which the two feeding stratgies used in EPaNIC were employed in a population not subject to tight glucose control. This would inform whether the feeding strategy used in the first Leuven trial might have increased mortality in the convential control arm. However, I am not sure that such a trial is justifiable. It is plausible that intravenously administering large amounts of glucose to critically ill patients is harmful and that the harm is ameliorated by large doses of insulin. 

    The trial proposed by Mazeraud and colleagues will tell us whether liberal and restrictive glucose sdministration modifies the effect of IIT; it will do nothing to settle the fundamental question of whether IIT is beneficial.

    Competing interests

    Principal investigator of the NICE SUGAR Study

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