Indication and practical use of intensive insulin therapy in the critically ill.
OBJECTIVE
Two large randomized studies demonstrated that maintenance of normoglycemia with intensive insulin therapy for at least a few days decreases morbidity and mortality of critically ill patients. This review gives an overview of the benefits associated with this therapy and highlights the importance of achieving optimal blood glucose levels. It discusses the indications for this therapy and the fear for potential harm.


RESULTS
A pooled analysis of the two Leuven studies (n = 2748) revealed a significantly reduced morbidity and mortality in critically ill patients for all subgroups, except those with a prior history of diabetes. An absolute reduction in risk of hospital death of 3-4% is to be expected from this therapy in an intention-to-treat analysis. When patients are treated for more than 3 days, the absolute reduction in risk of death increases to approximately 8%. The available data indicate that strict normoglycemia is required to obtain optimal clinical benefit. This increases the risk of hypoglycemia, but it remains unclear whether this is truly harmful in the setting of critical care.


CONCLUSIONS
Maintaining strict normoglycemia by the use of intensive insulin therapy improves outcome of critically ill patients.
Mebis
Liese
L
Department of Intensive Care Medicine, Catholic University of Leuven, Leuven, Belgium.
Gunst
Jan
J
Langouche
Lies
L
Vanhorebeek
Ilse
I
Van den Berghe
Greet
G
D001530:Belgium; D001786:Blood Glucose / Q000032:analysis; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D006943:Hyperglycemia; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
D001786:Blood Glucose; D007328:Insulin