title: Intensive insulin therapy versus conventional glycemic control in patients with acute neurological injury: a prospective controlled trial.
abstract: 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.
authors.affiliation: Intensive Care Units of Hospital São Domingos and Hospital Dr. Clementino Moura, 65072-820 São Luis, MA, Brazil. jrazevedo@elo.com.br
authors.forename: José Raimundo A de
authors.initials: JR
authors.lastname: Azevedo
authors.forename: Eduardo Rodrigues M
authors.initials: ER
authors.lastname: Lima
authors.forename: Rachel Jorge Dino
authors.initials: RJ
authors.lastname: Cossetti
authors.forename: Renato Palácio de
authors.initials: RP
authors.lastname: Azevedo
mesh_terms: 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
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin