Is "safe effective glucose control" effective and safe?

Of note, the randomized controlled trials that showed a benefit from glucose control have tested only one and the same BGL target (4.4 to 6.1 mmol/l [80 to 110 mg/dl]) [2,3]. In addition, in these trials conventional insulin treatment was administered only when the BGL was >12 mmol/L (215 mg/dl), with insulin infusion gradually decreased and stopped when the BGL fell to <10 mmol/l (180 mg/dl). Accordingly, the average morning BGL of the conventional treatment group was approximately 8.5 mmol/l (150 mg/dl). Therefore, it is difficult to understand why this level is now the recommended BGL target in what Krinsley and Preiser label ”safe” and “effective” glucose control. Avoiding hypoglycemia may definitely be “safe”, but advocating a target similar to the control group of the two trials has definitely not been shown to be “effective” in improving outcome. It is incorrect advice in the light of evidence-based medicine (there simply is no evidence for the benefit of using higher BGL targets) and could adversely lead to more patients with higher BGLs, which would eventually worsen outcome [4].