Intensive insulin therapy in the intensive care unit: update on clinical impact and mechanisms of action.
OBJECTIVE
Hyperglycemia is a common feature of the critically ill and has been associated with increased mortality. In this review, we give an overview of studies associating critical illness-induced hyperglycemia with adverse outcome and describe how mortality and morbidity are affected when blood glucose levels are strictly controlled to normoglycemia with intensive insulin therapy.


RESULTS
Maintaining normoglycemia with intensive insulin therapy improves survival rates and reduces morbidity in prolonged critically ill patients in both surgical and medical intensive care units (ICUs), as shown by 2 large randomized controlled studies. Prevention of cellular glucose toxicity by strict glycemic control appears to play a predominant role, but other metabolic and nonmetabolic effects of insulin also seem to contribute to the clinical benefits of this therapy.


CONCLUSIONS
These data support the generalized implementation of a strict blood glucose control management with intensive insulin therapy in adult surgical as well as medical ICU patients.
Vanhorebeek
Ilse
I
Department of Intensive Care Medicine, Katholieke Universiteit, Leuven, Leuven, Belgium.
Langouche
Lies
L
Van den Berghe
Greet
G
D001786:Blood Glucose / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use*; D007362:Intensive Care Units; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin