Intensive Glucose Control As detailed in the 2004 STEMI guideline,153 2007 UA/ NSTEMI guideline revision,4 and 2009 STEMI and PCI focused update,154 randomized trial evidence supported use of insulin infusion to control hyperglycemia. A clinical trial of intensive versus conventional glucose control in critically ill patients raised uncertainty about the optimal level to target when achieving glucose control. NICE-SUGAR (Normogly- caemia in Intensive Care Evaluation Survival Using Glu- cose Algorithm Regulation), a large international randomized trial (n 6104) of adults admitted to the intensive care unit with either medical or surgical conditions, compared inten- sive glucose control (target glucose range, 81 to 108 mg/dL) with conventional glucose control (to achieve a glucose level of 180 mg/dL, with reduction and discontinuation of insulin if the blood glucose level dropped below 144 mg/dL).149 Time-weighted glucose levels achieved were 115 18 mg/dL in the intensive group versus 144 23 mg/dL in the conven- tional group. The risk of death was increased at 90 days in the 95% CI: 1.02 to 1.08; P 0.02; number needed to harm 38). The result remained the same after adjusting for potential confounders. There were significantly more episodes of treatment-related hypoglycemia in the intensely managed group (6.8% versus 0.5%; P 0.001), although the contribu- tion of hypoglycemia to excess mortality is uncertain.149,150 Overall, the hospital course and proximate causes of death were similar in the 2 groups. Excess deaths in the intensive management group were predominantly of cardiovascular causes (absolute difference: 5.8%; P 0.02). More patients in the intensive group than in the conventional group were treated with corticosteroids. Because NICE-SUGAR149 enrolled critically ill medical and surgical patients, the degree to which its results can be extrapolated to the management of patients with UA/ NSTEMI is unclear. 