Molecular mechanisms by which metabolic control may improve outcomes.
OBJECTIVE
To summarize available evidence providing potential explanations for metabolic and nonmetabolic abnormalities during conditions of acute stress and possible mechanisms whereby insulin therapy may affect these changes.


RESULTS
Recent studies have demonstrated a remarkable effect of intensive insulin therapy and reductions in morbidity and mortality in patients in intensive-care units and other hospital settings. The mechanisms involved in these effects are under thorough investigation. Insulin therapy improves glucose and lipid homeostasis, both of which are deleterious to the tissues, especially during severe stress. In addition, insulin has direct effects on the levels of inflammatory cytokines and other proteins that may influence the overall outcome of patients undergoing various stressful conditions.


CONCLUSIONS
Analysis of published studies suggests that the beneficial effects of insulin therapy may be derived from both direct and indirect mechanisms.
Le Roith
Derek
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Diabetes Branch, National Institutes of Health, Bethesda, Maryland, USA.
D000208:Acute Disease; D001775:Blood Circulation / Q000187:drug effects; D001786:Blood Glucose / Q000378:metabolism; D001808:Blood Vessels / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005947:Glucose / Q000008:administration & dosage / Q000378:metabolism; D006706:Homeostasis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007333:Insulin Resistance; D007362:Intensive Care Units; D050356:Lipid Metabolism; D009203:Myocardial Infarction / Q000188:drug therapy; D012720:Severity of Illness Index; D013312:Stress, Physiological / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism* / Q000503:physiopathology
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005947:Glucose