Comparison of efficacy of different glucose control strategies in critically ill adults: a network meta-analysis of randomized controlled trials
Authors' conclusion
Liberal glucose control is the optimal strategy for most ICU patients, balancing mortality reduction and safety. In surgical ICUs, strict control may be considered but requires vigilant hypoglycemia monitoring.
Study context
- Population
- Critically ill adults in the Intensive Care Unit (ICU); Randomized Controlled Trials (RCTs) searched in PubMed, Embase, Cochrane Library and Web of Science to August 28, 2025
- Participants
- 31,556 adults63 trials
- Comparison
- Strict vs intermediate strict vs liberal vs very liberal glucose control
- Outcome
- All-cause mortality
Methodological detailsfrequentist random-effects models, surface under the cumulative ranking (SUCRA) ranking, RoB 2.0
- Frequentist random-effects models
- SUCRA ranking
- RoB 2.0
Pooled result
As reported in the abstract
| Group | SUCRA |
|---|---|
| Liberal | 0.8720 |
Liberal
SUCRA0.8720
- Liberal control ranked highest in reducing mortality (SUCRA)
- 0.8720
Further pooled results
Surgical ICU subgroup
- Potential benefit from strict control, though requiring intensified monitoring
Safety
Adverse events, especially hypoglycaemia risk
- Significant heterogeneity in adverse events (I2)
- 75.8 %
- p < 0.01
Original publication
Comparison of efficacy of different glucose control strategies in critically ill adults: a network meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. Published 5 December 2025. doi:10.
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