Sci-Bytes> Hot Paper in Medicine
Week of March 20, 2011
"Intensive versus conventional glucose control in critically ill patients," by the NICE-SUGAR Study Investigators (S. Finfer, et al.), New England Journal of Medicine, 360(13): 1283-97, 26 March 2009.
[Authors’ affiliations (writing committee): 18 Australian and Canadian institutions]
Abstract: "Background: The optimal target range for blood glucose in critically ill patients remains unclear.
Methods: Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter (4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per deciliter (10.0 mmol or less per liter). We defined the primary end point as death from any cause within 90 days after randomization.
Results: Of the 6104 patients who underwent randomization, 3054 were assigned to undergo intensive control and 3050 to undergo conventional control; data with regard to the primary outcome at day 90 were available for 3010 and 3012 patients, respectively. The two groups had similar characteristics at baseline. A total of 829 patients (27.5%) in the intensive-control group and 751 (24.9%) in the conventional-control group died (odds ratio for intensive control, 1.14; 95% confidence interval, 1.02 to 1.28; P = 0.02). The treatment effect did not differ significantly between operative (surgical) patients and nonoperative (medical) patients (odds ratio for death in the intensive-control group, 1.31 and 1.07, respectively; P = 0.10). Severe hypoglycemia (blood glucose level, = 40 mg per deciliter [2.2 mmol per liter]) was reported in 206 of 3016 patients (6.8%) in the intensive-control group and 15 of 3014 (0.5%) in the conventional-control group (P<0.001). There was no significant difference between the two treatment groups in the median number of days in the ICU (P = 0.84) or hospital (P = 0.86) or the median number of days of mechanical ventilation (P = 0.56) or renal-replacement therapy (P = 0.39).
Conclusions: In this large, international, randomized trial, we found that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg or less per deciliter resulted in lower mortality than did a target of 81 to 108 mg per deciliter."
This 2009 report from the New England Journal of Medicine was cited 52 times in current journal articles indexed by Clarivate during November-December 2010. During that two-month period, this was the third-most-cited medicine paper published in the last two years, aside from reviews. Prior to the most recent bimonthly count, citations to the paper have accrued as follows:
September-October 2010: 55 citations
July-August 2010: 39
May-June 2010: 56
March-April 2010: 54
January-February 2010: 46
November-December 2009: 39
September-October 2009: 24
July-August 2009: 25
May-June 2009: 13
March-April 2009: 1
Total citations to date: 404
SOURCE: Hot Papers Database (Included with a subscription to the print newsletter Science Watch®, available from the Research Services Group of Thomson Reuters. Packaged on a CD that is mailed with each Science Watch issue, the Hot Papers Database contains data on hundreds of highly cited papers published during the last two years. User interface permits searching by author, organization, journal, field, and more. Total citations, as well as citations accrued during successive bimonthly periods, can be assessed and graphed.
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