title: Intensive insulin therapy for septic patients: a meta-analysis of randomized controlled trials.
abstract: Background. Studies on the effect of intensive insulin therapy (IIT) in septic patients with hyperglycemia have given inconsistent results. The primary purpose of this meta-analysis was to evaluate whether it is effective in reducing mortality. Methods. We searched PubMed, Embase, the Cochrane Library, clinicaltrials.gov, and relevant reference lists up to September 2013 and including randomized controlled trials that compared IIT with conventional glucose management in septic patients. Study quality was assessed using the Cochrane Risk of Bias Tool. And our primary outcome measure was pooled in the random effects model. Results. We identified twelve randomized controlled trials involving 4100 patients. Meta-analysis showed that IIT did not reduce any of the outcomes: overall mortality (risk ratio [RR] = 0.98, 95% CI [0.85, 1.15], P = 0.84), 28-day mortality (RR = 0.66, 95% CI [0.40, 1.10], P = 0.11), 90-day mortality (RR = 1.10, 95% CI [0.97, 1.26], P = 0.13), ICU mortality (RR = 0.94, 95% CI [0.77, 1.14], P = 0.52), hospital mortality (RR = 0.98, 95% CI [0.86, 1.11], P = 0.71), severity of illness, and length of ICU stay. Conversely, the incidence of hypoglycemia was markedly higher in the IIT (RR = 2.93, 95% CI [1.69, 5.06], P = 0.0001). Conclusions. For patients with sepsis, IIT and conservative glucose management show similar efficacy, but ITT is associated with a higher incidence of hypoglycemia.
authors.affiliation: School of Medicine, Zhejiang University, Yuhangtang Road 866, Hangzhou 310058, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Song
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, China.
authors.forename: Liu-Jun
authors.initials: LJ
authors.lastname: Zhong
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Han
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, China.
authors.forename: Guo-Hao
authors.initials: GH
authors.lastname: Xie
authors.affiliation: Department of Surgical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Xiao
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhao
authors.affiliation: Department of Surgery, Children's Hospital, School of Medicine, Zhejiang University, Zhuganxiang 57, Hangzhou 310003, China.
authors.forename: Yao-Qin
authors.initials: YQ
authors.lastname: Hu
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, China.
authors.forename: Shu-Yan
authors.initials: SY
authors.lastname: Wang
authors.affiliation: Department of Surgery, Children's Hospital, School of Medicine, Zhejiang University, Zhuganxiang 57, Hangzhou 310003, China.
authors.forename: Chao-Jin
authors.initials: CJ
authors.lastname: Qin
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Children's Hospital, School of Medicine, Zhejiang University, Zhuganxiang 57, Hangzhou 310003, China.
authors.forename: Deng-Ming
authors.initials: DM
authors.lastname: Lai
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Cui
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, China.
authors.forename: Xiang-Ming
authors.initials: XM
authors.lastname: Fang
mesh_terms: D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D007003:Hypoglycemia / Q000139:chemically induced / Q000473:pathology*; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use; D007362:Intensive Care Units; D039781:PubMed; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D007328:Insulin