Intensive insulin therapy versus conventional glycemic control in patients with acute neurological injury: a prospective controlled trial.
OBJECTIVE
To compare intensive insulin therapy to conventional glycemic control in patients with acute neurological injury evaluating neurological outcome and morbimortality.


METHODS
Patients with two glycemias above 150 mg/dL 12 hours after admission were randomized to receive intensive insulin therapy (G1) or conventional treatment (G2). We evaluated a subgroup of patients with acute brain injury from July, 2004 to June, 2006.


RESULTS
G1 patients (n=31) received 70.5 (45.1-87.5) units of insulin/day while G2 patients (n=19) received 2 (0.6-14.1) units/day (p<0.0001). The median glycemia was comparable in both groups (p=0.16). Hypoglycemia occurred in 2 patients (6.4%) in G1 and in 1 patient (5.8%) in G2 (p=1.0). Mortality in G1 was of 25.8% and of 35.2% in G2 (relative reduction of 27%). Neurological outcome was similar in both groups.


CONCLUSIONS
A less strict intensive insulin therapy can reduce hypoglycemia and still maintain its benefits.
Azevedo
José Raimundo A de
JR
Intensive Care Units of Hospital São Domingos and Hospital Dr. Clementino Moura, 65072-820 São Luis, MA, Brazil. jrazevedo@elo.com.br
Lima
Eduardo Rodrigues M
ER
Cossetti
Rachel Jorge Dino
RJ
Azevedo
Renato Palácio de
RP
D000208:Acute Disease; D001786:Blood Glucose / Q000032:analysis*; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin