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Intensive insulin therapy for critically ill patients
Kelly S Lewis1, Sandra L Kane-Gill, Mary Beth Bobek
1Associate Professor of Anesthesiology, Division of Critical Care, Rush Presbyterian St Luke's Medical Center, Chicago, IL, USA.
The Annals of Pharmacotherapy
|June 10, 2004
Summary
Intensive insulin therapy in critically ill patients improves blood glucose control, reducing both morbidity and mortality. Strict glucose monitoring is essential to avoid hypoglycemia and achieve normoglycemia.
Area of Science:
- Critical care medicine
- Endocrinology
- Pharmacology
Background:
- Hyperglycemia is prevalent in critically ill patients, often unrelated to pre-existing diabetes.
- High blood glucose levels contribute to sepsis and multisystem organ failure, major causes of death in critical illness.
Purpose of the Study:
- To assess the clinical outcomes of intensive insulin therapy in critically ill patients.
- To define the role of intensive insulin therapy in managing critically ill individuals.
Main Methods:
- Comprehensive literature search of MEDLINE and Cochrane Library (1966-March 2004).
- Inclusion criteria focused on studies evaluating clinical outcomes related to hyperglycemia and insulin therapy.
- Manual review of abstracts and relevant articles for data synthesis.
Main Results:
- Intensive insulin therapy to maintain normoglycemia improves neurologic, cardiovascular, and infectious outcomes.
- Aggressive insulin treatment significantly reduces morbidity and mortality in critically ill patients.
- Protocols for strict glucose control can be implemented based on these findings.
Conclusions:
- Insulin protocols enhance glycemic control in critically ill patients, lowering morbidity and mortality.
- Achieving normoglycemia through insulin protocols is recommended for all critically ill patients, irrespective of diabetes history.
- Frequent glucose monitoring is crucial to prevent hypoglycemia.