title: Early versus late intravenous insulin administration in critically ill patients.
abstract: OBJECTIVE
  To investigate whether timing of intensive insulin therapy (IIT) after intensive care unit (ICU) admission influences outcome.
  
  
  METHODS
  Single-center prospective cohort study in the 14-bed medical ICU of a 1,171-bed tertiary teaching hospital.
  
  
  METHODS
  The study included 127 patients started on ITT within 48 h of ICU admission (early group) and 51 started on ITT thereafter (late group); the groups did not differ in age, gender, race, BMI, APACHE III, ICU steroid use, admission diagnosis, or underlying comorbidities.
  
  
  RESULTS
  The early group had more ventilator-free days in the first 28 days after ICU admission (median 12 days, IQR 0-24, vs. 1 day, 0-11), shorter ICU stay (6 days, IQR 3-11, vs. 11 days, vs. 7-17), shorter hospital stay (15 days, IQR 9-30, vs. 25 days, 13-43), lower ICU mortality (OR 0.48), and lower hospital mortality (OR 0.27). On multivariate analysis, early therapy was still associated with decreased hospital mortality (ORadj 0.29). The strength and direction of association favoring early IIT was consistent after propensity score modeling regardless of method used for analysis.
  
  
  CONCLUSIONS
  Early IIT was associated with better outcomes. Our results raise questions about the assumption that delayed administration of IIT has the same benefit as early therapy. A randomized study is needed to determine the optimal timing of therapy.
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Shyoko
authors.initials: S
authors.lastname: Honiden
authors.forename: Atara
authors.initials: A
authors.lastname: Schultz
authors.forename: Shelly A
authors.initials: SA
authors.lastname: Im
authors.forename: David M
authors.initials: DM
authors.lastname: Nierman
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Gong
mesh_terms: D016638:Critical Illness; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007362:Intensive Care Units; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin