Beyond blood glucose targets: integrating glucose variability into acute glycemic care in French ICUs - a multicenter prospective study - 28/10/26

Doi : 10.1016/j.aicoj.2026.100193

Suzanne Goursaud ^a,^b,⁎ , Toufik Kamel ^c, Amandine Thierry ^c, Laetitia Bodet-Contentin ^d, Nahila Himer ^e, Vanessa Zinzoni ^f, Paul-Henry Wicky ^g, Julien Lorber ^h, Guylaine Labro ⁱ, Anne-Astride Bourion ^j, Sarah Noir ^k, Evelina Ochin ^l, Nathalie Regnier ^m, Thibault Noel ⁿ, Célina Morand ^o, Adrien Auvet ^p, Aude Garin ^q, David Schnell ^r, Vanessa Jean-Michel ^s, David Joganah ^t, Constance Grignon ^u, Emmanuelle Mercier ^v, Bertrand Hermann ^w,^x, Claire Dupuis ^y, Laurent Poiroux ^z

for the SRLF Trial Group

^a Department of Medical Intensive Care, Caen University Hospital, Caen, France

^b Normandie Univ, UNICAEN, INSERM UMRS U1237 PhIND, Caen, France

^c Medical Intensive Care, Orléans University Hospital, Orléans, France

^d Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Tours, Paris, France

^e Réanimation Polyvalente, Hôpital Nord Franche-Comté, Trévenans, France

^f Intensive Care Department, La Roche-sur-Yon Hospital, La Roche-Sur-Yon, France

^g Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris Diderot University, Paris, France

^h Department of Intensive Care Medicine, Hospital of Saint-Nazaire, Saint-Nazaire, France

ⁱ Service de Médecine Intensive-Réanimation Groupement Hospitalier Régional Mulhouse Et Sud Alsace, Hôpital Emile Muller, Mulhouse, France

^j Réanimation, Centre Hospitalier de Cholet, Cholet, France

^k Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Besançon, Besançon, France

^l Service de Réanimation Polyvalente et d'Unité de Surveillance Continue, Hôpital Simone Veil, Eaubonne, France

^m Intensive Care Unit, Ouest Parisien Private Hospital, Ramsay Générale de Santé, Trappes, France

ⁿ Association Hospitalière Sainte Marie, Centre Hospitalier Sainte Marie de Clermont-Ferrand, Clermont-Ferrand, France

^o Service de Médecine intensive-Réanimation, CHU Poitiers, France

^p Intensive Care Unit, Dax Hospital, Dax, France

^q Service de Réanimation Polyvalente, Centre Hospitalier de Dreux, Dreux, France

^r Médecine Intensive Réanimation, Centre Hospitalier Régional Universitaire (CHRU) de Tours, France

^s Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Chatiliez, Tourcoing, France

^t Service de Reanimation, Centre Hospitalier de Haguenau, Haguenau, France

^u Department of Anesthesiology, CHU Nantes, Université de Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, France

^v Service de Médecine Intensive Réanimation, CHU de Tours, Tours, France

^w Inserm 1266, Institute of Psychiatry and Neurosciences of Paris, Université Paris Cité, Paris F-75014, France

^x Medical Intensive Care Unit, HEGP Hôpital, Assistance Publique - Hôpitaux de Paris-Centre (APHP-Centre), Paris 75014, France

^y Department of Medical Intensive Care, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; Université Clermont Auvergne, Human Nutrition Unit, INRAe, CRNH Auvergne, Clermont-Ferrand, France

^z Nursing Department, Health Faculty of the University of Angers, France

^⁎ Corresponding author.

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Abstract

Background

Although hyperglycemia is a common adaptative response in hospitalized intensive care units (ICUs) patients, there are no recommendations regarding blood glucose management protocols. Consequently, practices differ between ICUs. We aimed to prospectively describe glucose management in French-speaking ICUs with the main objective to assess the impact of glucose management on glucose variability within the first 48 h of insulin infusion.

Results

A total of 650 patients from 38 ICUs across France and Belgium were included with 649 patients analyzed. Management with tighter glucose targets did not result in an increase in Glycemic Lability Index (OR 0.79, 95% CI [0.51-1.21]; p = 0.28) but episodes of severe hypoglycemia were more frequent in tight blood glucose control group. Nurse workload did not impact glucose variability significantly. Deviations from the protocol were frequent in 24.9% of cases, independently to the blood glucose target used. Percentage spent in the target range was significantly higher in the liberal group ( p < 0.01). ICU mortality rate was higher in patients who had at least one episode of hypoglycemia < 3.9 mmol/L ( p = 0.04), and lower in patients with at least one episode of hyperglycemia > 11.1 mmol/L ( p = 0.04).

Conclusions

Despite heterogenous practices through French speaking ICUs, management with tight blood glucose targets did not significantly impact glucose variability but was associated with higher incidence of severe hypoglycemia.

Le texte complet de cet article est disponible en PDF.

Keyword : Glucose variability, hypoglycemia, hyperglycemia, glycemic control, insulin, intensive care

Abbreviations : GLI, GluCV, GV, ICU, P/N ratio, SAPS II, SOFA