title: Failure to achieve glycemic control despite intensive insulin therapy in a medical ICU: incidence and influence on ICU mortality.
abstract: OBJECTIVE
  Intensive insulin therapy reduces mortality in subgroups of intensive care unit (ICU) patients, and awareness of the importance of blood glucose level (BGL) control has increased among ICU physicians and nurses. The impact of insulin treatment strategies on mortality may be influenced by their efficacy in achieving the target BGL range. We assessed the efficacy of an insulin treatment strategy in maintaining BGL within the target range, and we compared ICU mortality in patients who did and did not reach the BGL target.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  12-bed medical ICU in a tertiary teaching hospital.
  
  
  METHODS
  Adults consecutively admitted over a 9-month period to an ICU where standard care included an insulin treatment strategy aimed at maintaining BGL<or=7 mmol/l.
  
  
  RESULTS
  105 patients were included. Median SAPS II was 45 (31-54). Failure to control BGL (mean capillary BGL >7 mmol/l after initial hyperglycemia correction) occurred in 32 patients (31.1%) and was associated with a significant increase in ICU mortality (56.2 vs. 23.3% in patients with successful BGL control). In the multivariate analysis, failure to control BGL independently predicted death in the ICU (OR 5.9, 2.1-16.6, p<0.001).
  
  
  CONCLUSIONS
  Failure to control BGL despite intensive insulin therapy was common and independently associated with ICU mortality. Failure to control BGL may considerably affect the overall impact of insulin treatment strategies on mortality.
authors: Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Poissy-St-Germain, 10 rue du Champ Gaillard, 78300, Poissy, France. jclacherade@chi-poissy-st-germain.fr.
authors: Jean-Claude
authors: JC
authors: Lacherade
authors: Hôpital Henri-Mondor AP-HP, 51 avenue du Maréchal de Tassigny, 94000, Créteil, France.|Faculté de Médecine de Bobigny, EA 3409, Université Paris XIII, 74 rue Marcel Cachin, 93000, Bobigny, France.
authors: Patricia
authors: P
authors: Jabre
authors: Hôpital Henri-Mondor AP-HP, 51 avenue du Maréchal de Tassigny, 94000, Créteil, France.
authors: Sylvie
authors: S
authors: Bastuji-Garin
authors: Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Poissy-St-Germain, 10 rue du Champ Gaillard, 78300, Poissy, France.
authors: David
authors: D
authors: Grimaldi
authors: Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Poissy-St-Germain, 10 rue du Champ Gaillard, 78300, Poissy, France.
authors: Pascal
authors: P
authors: Fangio
authors: Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Poissy-St-Germain, 10 rue du Champ Gaillard, 78300, Poissy, France.
authors: Valerie
authors: V
authors: Théron
authors: Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Poissy-St-Germain, 10 rue du Champ Gaillard, 78300, Poissy, France.
authors: Hervé
authors: H
authors: Outin
authors: Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Poissy-St-Germain, 10 rue du Champ Gaillard, 78300, Poissy, France.
authors: Bernard
authors: B
authors: De Jonghe
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017211:Treatment Failure
chemical_list: D001786:Blood Glucose; D007328:Insulin