Benefits and Risks of Intensive Glucose Control in Intensive Care Units: A Meta‐Analysis of Randomized Controlled Trials

BACKGROUND: Hyperglycaemia is common among intensive care unit (ICU) patients and is associated with increased mortality. However, whether intensive or liberal glucose control is more beneficial remains controversial. AIM: To compare the benefits and risks of intensive versus liberal glucose control in ICU patients. STUDY DESIGN: A Meta analysis of randomized controlled trials. METHODS: Systematic review and meta-analysis of randomized controlled trials (RCTs). We systematically searched PubMed, Cochrane Library, Embase and Web of Science from inception to October 30, 2024. The review was conducted according to PRISMA guidelines. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were independently screened and extracted by four reviewers. Relative risks (RRs) were pooled using a random effects model, and trial sequential analysis was performed for the primary outcome. RESULTS: Seventy RCTs were included, comprising 36 502 patients, of which 64 RCTs (32 491 patients, 89%) were conducted in adults and 6 RCTs (4011 patients, 11%) in children. The RR of all-cause mortality after intensive and liberal glucose control was 0.99 (95% CI, 0.93-1.05) in adults. Comparable findings were observed for all-cause mortality in children. Intensive glucose control had a statistically significantly higher risk of severe hypoglycaemia in both children (RR 5.70; 95% CI 2.60-12.51) and adults (RR 3.55; 95% CI 2.49-5.07). However, intensive glucose control had a statistically lower risk of infection in both children (RR 0.83; 95% CI 0.70-0.98) and adults (RR 0.78; 95% CI 0.63-0.97). In the subgroup analysis of adults, a lower risk of infection was observed in all surgical groups, but not in the medical group. There was no statistically significant difference in other complications, including sepsis, acute renal injury, new need for dialysis and need for blood transfusion. CONCLUSIONS: Intensive and liberal glucose control had similar effects on all-cause mortality in adults and children, though paediatric data are limited and should be interpreted cautiously. Intensive glucose control reduced infection risk, especially in surgical ICUs, but increased the risk of severe hypoglycaemia. RELEVANCE TO CLINICAL PRACTICE: These findings suggest that routine intensive glucose control does not improve survival and should be applied cautiously due to increased hypoglycaemia risk, although it may reduce infection risk, particularly in surgical ICU patients.