Choosing the correct metrics for glucose control

In an attempt to determine whether strict glucose control (SGC) [1] was adopted in ICUs in Australia and New Zealand (ANZ) before or after the publication of NICE-SUGAR (Normoglycemia in Intensive Care Evaluation and Surviving Using Glucose Algorithm Regulation) [2], Kaukonen and colleagues examined the ‘mean of the highest and lowest blood glucose level in the first 24 hours after ICU admission’ (Glu1) [3]. Assuming that a median Glu1 of less than 6.44 mmol/L is an indicator of adoption of SGC, they conclude that SGC was not adopted before NICE-SUGAR and that this trial led to an even looser glucose control in their continent. As the Glu1 is calculated from blood glucose values in the first 24 hours, this metric by definition will not reflect what happens beyond the first day of ICU admission. Second, ICU algorithms for glucose control