title: Comparison of metformin and insulin in the control of hyperglycaemia in non-diabetic critically ill patients.
abstract: BACKGROUND
  It is accepted that preventing hyperglycaemia during critical illness while assuring adequate caloric intake can reduce mortality and morbidity. The aim of this study was to compare the metabolic effects of metformin and insulin on hyperglycaemia in ICU patients.
  
  
  METHODS
  This double-blind randomised clinical trial was performed on 24 patients who were admitted to the intensive care unit (ICU) from 20 March to 20 September 2007. All patients with serious injuries or with major non-abdominal surgeries were included if they met the inclusion criteria, and were assigned randomly to one of the study groups. Patients in Group 1 received intensive insulin therapy, and patients in Group 2 were treated with metformin. Moreover, the Acute Physiology And Chronic Health Evaluation (APACHE) II scoring system was used to grade disease severity.
  
  
  RESULTS
  Both glycaemic management protocols led to significantly improved glucose levels without any report of hypoglycaemia. The mean initial glucose levels for the insulin group decreased significantly after the intravenous infusion of insulin (p < 0.001). Additionally, the blood glucose concentration was significantly lower after two weeks of metformin administration compared to baseline measurements (p < 0.001). Moreover, the blood glucose concentration decrease during these two weeks was significantly higher in the insulin group (p = 0.01). Besides, APACHE II score was lower than baseline at the end of the study for both therapeutic groups (score of 10 vs. 15 [insulin] and 16 [metformin]). Finally, new renal dysfunction (maximum serum creatinine level at least double the initial value) was observed in three of the patients (two patients from the metformin group and one from the insulin group) in the last days of the protocol, although none of the patients showed lactic acidosis after ICU admission.
  
  
  CONCLUSIONS
  Both metformin and intensive insulin therapy significantly decreased hyperglycaemia in ICU patients. Insulin caused a greater reduction in blood glucose concentration but required more attention and trained personnel.
authors: Faculty of Pharmacy and Pharmaceutical Sciences Research Centre, Teheran University of Medical Sciences, Teheran, Iran.
authors: Mojtaba
authors: M
authors: Mojtahedzadeh
authors: Arash
authors: A
authors: Jafarieh
authors: Atabak
authors: A
authors: Najafi
authors: Mohammad Reza
authors: MR
authors: Khajavi
authors: Neda
authors: N
authors: Khalili
mesh_terms: D018806:APACHE; D000328:Adult; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003422:Critical Care; D016638:Critical Illness; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007362:Intensive Care Units; D007492:Iran; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin