Intensive insulin therapy in critically ill patients

Area of Science:

• Critical Care Medicine
• Endocrinology
• Metabolic Disorders

Background:

• Critically ill patients frequently experience hyperglycemia and insulin resistance, irrespective of prior diabetes status.
• The impact of normalizing blood glucose levels through insulin therapy on patient prognosis remains unclear.

Purpose of the Study:

• To investigate the effect of intensive insulin therapy on mortality and morbidity in critically ill adult patients.
• To compare intensive insulin therapy targeting 80–110 mg/dL with conventional glucose management.

Main Methods:

• A prospective, randomized, controlled trial was conducted in a surgical intensive care unit.
• Adults receiving mechanical ventilation were randomized to intensive insulin therapy or conventional treatment.
• Intensive therapy aimed for blood glucose 80–110 mg/dL; conventional therapy targeted 180–200 mg/dL, with insulin initiated only if glucose exceeded 215 mg/dL.

Main Results:

• Intensive insulin therapy reduced intensive care unit mortality from 8.0% to 4.6% (P<0.04).
• Benefits were most pronounced in patients with prolonged ICU stays (>5 days), with mortality dropping from 20.2% to 10.6% (P=0.005).
• Significant reductions were observed in in-hospital mortality (34%), bloodstream infections (46%), acute renal failure (41%), and critical-illness polyneuropathy (44%).

Conclusions:

• Intensive insulin therapy, maintaining blood glucose ≤110 mg/dL, effectively reduces morbidity and mortality in surgical intensive care unit patients.
• This approach lessens the need for prolonged mechanical ventilation and intensive care, improving overall patient outcomes.