Intensive insulin therapy in severely burned pediatric patients: a prospective randomized trial.
BACKGROUND
Hyperglycemia and insulin resistance have been shown to increase morbidity and mortality in severely burned patients, and glycemic control appears essential to improve clinical outcomes. However, to date no prospective randomized study exists that determines whether intensive insulin therapy is associated with improved post-burn morbidity and mortality.


OBJECTIVE
To determine whether intensive insulin therapy is associated with improved post-burn morbidity.


METHODS
A total of 239 severely burned pediatric patients with burns over greater than 30% of their total body surface area were randomized (block randomization 1:3) to intensive insulin treatment (n = 60) or control (n = 179).


RESULTS
Demographics, clinical outcomes, sepsis, glucose metabolism, organ function, and inflammatory, acute-phase, and hypermetabolic responses were determined. Demographics were similar in both groups. Intensive insulin treatment significantly decreased the incidence of infections and sepsis compared with controls (P < 0.05). Furthermore, intensive insulin therapy improved organ function as indicated by improved serum markers, DENVER2 scores, and ultrasound (P < 0.05). Intensive insulin therapy alleviated post-burn insulin resistance and the vast catabolic response of the body (P < 0.05). Intensive insulin treatment dampened inflammatory and acute-phase responses by deceasing IL-6 and acute-phase proteins compared with controls (P < 0.05). Mortality was 4% in the intensive insulin therapy group and 11% in the control group (P = 0.14).


CONCLUSIONS
In this prospective randomized clinical trial, we showed that intensive insulin therapy improves post-burn morbidity. Clinical trial registered with www.clinicaltrials.gov (NCT00673309).
Jeschke
Marc G
MG
Shriners Hospitals for Children, Galveston, TX 77550, USA. majeschk@utmb.edu
Kulp
Gabriela A
GA
Kraft
Robert
R
Finnerty
Celeste C
CC
Mlcak
Ron
R
Lee
Jong O
JO
Herndon
David N
DN
D000410:Alanine Transaminase / Q000378:metabolism; D000469:Alkaline Phosphatase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001663:Bilirubin / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001806:Blood Urea Nitrogen; D001823:Body Composition; D015519:Bone Density; D002056:Burns / Q000150:complications* / Q000401:mortality*; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D003176:Complement C3 / Q000378:metabolism; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006242:Haptoglobins / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000209:etiology; D007003:Hypoglycemia / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007333:Insulin Resistance; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D009102:Multiple Organ Failure / Q000517:prevention & control; D011228:Prealbumin / Q000378:metabolism; D011446:Prospective Studies; D012177:Retinol-Binding Proteins / Q000378:metabolism; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control; D014168:Transferrin / Q000378:metabolism; D015599:Trauma Severity Indices; D014946:Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D000511:alpha-Macroglobulins / Q000378:metabolism
D015415:Biomarkers; D001786:Blood Glucose; D003176:Complement C3; D006242:Haptoglobins; D007004:Hypoglycemic Agents; D007328:Insulin; D015850:Interleukin-6; D011228:Prealbumin; D012177:Retinol-Binding Proteins; D014168:Transferrin; D000511:alpha-Macroglobulins; D002097:C-Reactive Protein; D003404:Creatinine; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin
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