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In Reply: Dr Scott and colleagues highlight one of the issues raised by our Editorial: problems related to the accuracy of measurement of blood glucose in the critically ill. They suggest that imprecision of bedside blood glucose measurement may be the predominant reason why subsequent studies and indeed the pooled results in the meta-analysis by Weiner et al¹ were not able to confirm the substantial reduction in mortality found in the original study of intensive insulin therapy reported by van den Berghe et al.²

To attribute the differences solely to potential inaccuracies in blood glucose measurement is to ignore the many other potential reasons why the treatment effect reported by van den Berghe et al² may be unique to that particular study. A population consisting largely of cardiac surgical patients, the relatively high mortality rate given the population, the use of large volumes of intravenous glucose, and the extensive use . . . [Full Text of this Article]

Simon Finfer, MBBS, FJFICM
sfinfer@george.org.au

Anthony Delaney, MBBS, FJFICM
Intensive Care Unit
Royal North Shore Hospital
Sydney, Australia

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