{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T06:45:26Z","timestamp":1793083526444,"version":"4.5.0"},"reference-count":63,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To perform an updated systematic review and meta-analysis of the efficacy and safety of intensive (INT) vs. conventional (CONV) blood glucose (BG) targets for critically ill adults on insulin infusions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources:<\/jats:title>\n                    <jats:p>We conducted a comprehensive search of Embase and OVID Medline databases from inception to October 16, 2023. We manually excluded studies published before 2000 due to potential lack of relevance as glycemic control in the ICU was not routinely practiced before 2000.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Selection:<\/jats:title>\n                    <jats:p>We included randomized controlled trials (RCTs) evaluating adult, critically ill patients on insulin infusions comparing INT vs. CONV targets for efficacy and safety outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Extraction:<\/jats:title>\n                    <jats:p>Data were screened and extracted with accuracy confirmed by a second reviewer. Study methodological characteristics, patient population, interventions, and outcome data were recorded. Studies without numerical outcomes were summarized as text statements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Synthesis:<\/jats:title>\n                    <jats:p>Forty-five RCTs were included involving 32,215 patients. No differences were seen between INT and CONV targets for hospital mortality or ICU mortality. INT targets were associated with lower ICU length of stay (LOS), infections, and critical illness polyneuropathy (CIP); however, INT targets demonstrated a 3.6-fold higher risk of severe hypoglycemia. Most of the studies with significant differences contained serious inconsistencies or risk of bias. In the subgroup analyses, INT targets demonstrated favorable neurologic outcomes in neurologic ICU patients, lower ICU LOS in mixed ICU patients, and lower ICU mortality in the cardiac surgery subgroup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>INT BG targets demonstrated mild to moderate improvements in several important morbidity secondary outcomes, including LOS, infections, and CIP, but were associated with a 3.6-fold higher risk of severe hypoglycemia. No differences were seen in ICU or hospital mortality. INT targets should not be routinely used over CONV targets when trying to minimize hypoglycemia as a marker of patient safety. However, as stated in the Society of Critical Care Medicine guidelines, a lower target within the INT range (110\u2013140\u2009mg\/dL; 6.1\u20137.8 mmol\/L) may be considered acceptable in select centers where the risk of hypoglycemia is documented to be negligible based on routine assessment and with the use of optimized glycemic management protocols.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/ccm.0000000000007175","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T15:26:47Z","timestamp":1781018807000},"page":"2090-2101","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Comparison of Intensive Versus Conventional Glycemic Control Targets: An Updated Systematic Review and Meta-Analysis of the 2024 Society of Critical Care Medicine Guidelines on Glycemic Control for Critically Ill Adults"],"prefix":"10.1097","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3119-5088","authenticated-orcid":false,"given":"Michael","family":"Sirimaturos","sequence":"first","affiliation":[{"name":"System Critical Care Pharmacy Services Leader, Houston Methodist Hospital, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimia","family":"Honarmand","sequence":"additional","affiliation":[{"name":"Division of Critical Care, Department of Medicine, Mackenzie Health, Vaughan, ON, Canada."},{"name":"GUIDE Canada, McMaster University, Hamilton, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micah T.","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Division of Critical Care, University of Wisconsin School of Medicine and Public Health, Madison, WI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Charles","family":"Preiser","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Erasme University Hospital, Brussels, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Dave","family":"Nagpal","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery and Critical Care Western, London Health Sciences Centre, London, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S. D.","family":"Agus","sequence":"additional","affiliation":[{"name":"Harvard Medical School and Division Chief, Medical Critical Care, Boston Children\u2019s Hospital, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janan","family":"Aldouhan","sequence":"additional","affiliation":[{"name":"King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas G.","family":"Bircher","sequence":"additional","affiliation":[{"name":"Department of Nurse Anesthesia, School of Nursing, University of Pittsburgh, Pittsburgh, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L.","family":"Carpenter","sequence":"additional","affiliation":[{"name":"Emory Critical Care Center, Atlanta, GA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Dearness","sequence":"additional","affiliation":[{"name":"Hamilton, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Farrington","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care Pharmacist, New Hanover Regional Medical Center, Wilmington, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amado X.","family":"Freire","sequence":"additional","affiliation":[{"name":"Pulmonary Critical Care and Sleep Medicine at the University of Tennessee Health Science Center, Memphis, TN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliotte L.","family":"Hirshberg","sequence":"additional","affiliation":[{"name":"Adult and Pediatric Critical Care Specialist, University of Utah School of Medicine, Salt Lake City, UT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon Y.","family":"Irving","sequence":"additional","affiliation":[{"name":"Department of Nursing and Clinical Care Services-Critical Care, University of Pennsylvania School of Nursing, Children\u2019s Hospital of Philadelphia, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S.","family":"Krinsley","sequence":"additional","affiliation":[{"name":"Emeritus, Vagelos Columbia University College of Physicians and Surgeons, Stamford Hospital, Stamford, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Lanspa","sequence":"additional","affiliation":[{"name":"Division of Critical Care, Intermountain Medical Center, Salt Lake City, UT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Prager","sequence":"additional","affiliation":[{"name":"Division of Critical Care, Western University, London, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology, Critical Care and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA."},{"name":"Department of Anesthesiology and Critical Care Medicine, Children\u2019s Hospital of Philadelphia, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo E.","family":"Umpierrez","sequence":"additional","affiliation":[{"name":"School of Medicine, Emory University, Atlanta, GA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie P.","family":"Wax","sequence":"additional","affiliation":[{"name":"Queen\u2019s University, Kingston, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Jacobi","sequence":"additional","affiliation":[{"name":"Lebanon, IN."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"R1-20260806","doi-asserted-by":"crossref","first-page":"e161","DOI":"10.1097\/CCM.0000000000006174","article-title":"Society of Critical Care Medicine guidelines on glycemic 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