Title: Intensive insulin therapy in mixed medical/surgical intensive care units: benefit versus harm
Authors: Van den Berghe, Greet ×
Wilmer, Alexander
Milants, Ilse
Wouters, Pieter
Bouckaert, Bernard
Bruyninckx, Frans
Bouillon, Roger
Schetz, Miet #
Issue Date: Nov-2006
Series Title: Diabetes vol:55 issue:11 pages:3151-3159
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.
ISSN: 0012-1797
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Laboratory of Intensive Care Medicine
Laboratory for Clinical Infectious and Inflammatory Disorders
Clinical and Experimental Endocrinology
Physical Medicine and Revalidation Section (-)
Department of Cellular and Molecular Medicine - miscellaneous
× corresponding author
# (joint) last author

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