open access

Vol 8, No 5 (2007): Practical Diabetology
Original articles (translated)
Published online: 2007-05-24
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Intensive insulin therapy in mixed medical/surgical intensive care units.Benefit vs. harm

Greet Van den Berghe, Alexander Wilmer, Ilse Milants, Pieter J. Wouters, Bernard Bouckaert, Frans Bruyninckx, Roger Bouillon, Miet Schetz
Diabetologia Praktyczna 2007;8(5):165-177.

open access

Vol 8, No 5 (2007): Practical Diabetology
Original articles (translated)
Published online: 2007-05-24

Abstract

Intensive insulin therapy (IIT) improves the outcome of prolonged critically ill patients, but concerns remain regarding potential harm and the optimal blood glucose level. These questions were addressed using the pooled dataset of two randomized controlled trials. Independent of parenteral glucose load, IIT reduced mortality from 23.6% to 20.4% in the intention-to-treat group (n = 2,748; p = 0.04) and from 37.9% to 30.1% among long stayers (n = = 1.389; p = 0.002), with no difference among short stayers (8.9% vs. 10.4%; n = 1,359; p = 0.4). Compared with blood glucose of 110–150 mg/dl, mortality was higher with blood glucose > 150 mg/dl [odds ratio 1.38 (95% CI 1.10-1.75); p = 0.007] and lower with < 110 mg/dl [0.77 (0.61-0.96); p = 0.02]. Only patients with diabetes (n = 407) showed no survival benefit of IIT. Prevention of kidney injury and critical illness polyneuropathy required blood glucose strictly < 110 mg/day, but this level carried the highest risk of hypoglycemia. Within 24 h of hypoglycemia, three patients in the conventional and one in the IIT group died (p = 0.0004) without difference in hospital mortality. No new neurological problems occurred in survivors who experienced hypoglycemia in intensive care units (ICUs). We conclude that IIT reduces mortality of all medical/surgical ICU patients, except those with a prior history of diabetes, and does not cause harm. A blood glucose target < 110 mg/day was most effective but also carried the highest risk of hypoglycemia.

Abstract

Intensive insulin therapy (IIT) improves the outcome of prolonged critically ill patients, but concerns remain regarding potential harm and the optimal blood glucose level. These questions were addressed using the pooled dataset of two randomized controlled trials. Independent of parenteral glucose load, IIT reduced mortality from 23.6% to 20.4% in the intention-to-treat group (n = 2,748; p = 0.04) and from 37.9% to 30.1% among long stayers (n = = 1.389; p = 0.002), with no difference among short stayers (8.9% vs. 10.4%; n = 1,359; p = 0.4). Compared with blood glucose of 110–150 mg/dl, mortality was higher with blood glucose > 150 mg/dl [odds ratio 1.38 (95% CI 1.10-1.75); p = 0.007] and lower with < 110 mg/dl [0.77 (0.61-0.96); p = 0.02]. Only patients with diabetes (n = 407) showed no survival benefit of IIT. Prevention of kidney injury and critical illness polyneuropathy required blood glucose strictly < 110 mg/day, but this level carried the highest risk of hypoglycemia. Within 24 h of hypoglycemia, three patients in the conventional and one in the IIT group died (p = 0.0004) without difference in hospital mortality. No new neurological problems occurred in survivors who experienced hypoglycemia in intensive care units (ICUs). We conclude that IIT reduces mortality of all medical/surgical ICU patients, except those with a prior history of diabetes, and does not cause harm. A blood glucose target < 110 mg/day was most effective but also carried the highest risk of hypoglycemia.
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Keywords

diabetes mellitus; intensive insulin therapy; intensive care unit

About this article
Title

Intensive insulin therapy in mixed medical/surgical intensive care units.Benefit vs. harm

Journal

Clinical Diabetology

Issue

Vol 8, No 5 (2007): Practical Diabetology

Pages

165-177

Published online

2007-05-24

Bibliographic record

Diabetologia Praktyczna 2007;8(5):165-177.

Keywords

diabetes mellitus
intensive insulin therapy
intensive care unit

Authors

Greet Van den Berghe
Alexander Wilmer
Ilse Milants
Pieter J. Wouters
Bernard Bouckaert
Frans Bruyninckx
Roger Bouillon
Miet Schetz

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