Tijdschrift voor geneeskunde vol:62 issue:14-15 pages:1011-1017
Hyperglycemia is a common feature of the critically ill and has been associated with increased mortality. Maintaining normal blood glucose levels with intensive insulin therapy improves survival and reduces morbidity in prolonged critically ill patients in both surgical and medical ICU, as demonstrated by two large randomized controlled studies. Particularly for cardiac surgery patients, the hospital survival benefit with insulin therapy is most pronounced and maintained up to 4 years after hospital discharge, without inducing a substantial burden for the patients, their relatives or society. Prevention of cellular glucose toxicity by strict blood glucose control appears to play a predominant role, though also other metabolic and non-metabolic effects of insulin appear to contribute to the clinical benefits of this therapy.