Could Susceptibility to Low Hematocrit Interference Have Compromised the Results of the NICE-SUGAR Trial?

The recently published findings of the Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR)1 trial have dramatically changed clinician attitudes toward the achievement of euglycemia in intensive care unit (ICU) patients (1). In defending the proof-of-concept studies that validated the efficacy of normalizing blood glucose in the ICU, Van den Berghe et al. pointed out numerous variances between their original studies and those of the NICE-SUGAR trial(2). They included differences in blood glucose targets, insulin administration, blood sampling, nutritional strategies, clinician expertise, and the relative accuracy of the glucose measurement devices. Recently, Clinical Chemistry presented a very interesting Q&A on the use of blood glucose meters to achieve tight glucose control in patients in the ICU(3). Because one of our ICUs participated in the NICE-SUGAR trial, we report here some interesting and relevant data that shed more light on the NICE-SUGAR trial, data that yield more questions than answers. In our 30-bed general systems ICU at the University of Alberta Hospital, point-of-care glucose concentrations can be measured in 2 different ways: respiratory therapists measure arterial blood gases, hemoglobin, electrolytes, and glucose values with the Radiometer 800 blood gas system (BGA) and nurses measure arterial blood and …