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Published on: June 11, 2012
Intensive insulin therapy in severely burned pediatric patients: a prospective randomized trial
Marc G Jeschke1, Gabriela A Kulp, Robert Kraft
1Shriners Hospitals for Children, Galveston, TX 77550, USA. majeschk@utmb.edu
Insights
Intensive insulin therapy in severely burned children significantly reduced infections and improved organ function. This approach alleviates post-burn insulin resistance and the body's catabolic response, enhancing recovery.
Area of Science:
- Pediatric critical care
- Burn management
- Endocrinology
Background:
- Hyperglycemia and insulin resistance increase morbidity and mortality in severely burned patients.
- Glycemic control is crucial for improving clinical outcomes in burn patients.
- No prior prospective randomized studies evaluated intensive insulin therapy's impact on post-burn outcomes.
Purpose of the Study:
- To determine if intensive insulin therapy improves post-burn morbidity in severely burned pediatric patients.
- To assess the effects of intensive insulin therapy on mortality, sepsis, organ function, and metabolic responses.
Main Methods:
- A prospective randomized trial involving 239 severely burned pediatric patients (burns >30% total body surface area).
- Patients were randomized to intensive insulin treatment (n=60) or standard care (control, n=179).
- Evaluated outcomes included infection rates, sepsis, organ function markers, inflammatory responses, and mortality.
Main Results:
- Intensive insulin therapy significantly reduced infections and sepsis compared to controls (P < 0.05).
- Improved organ function was observed, indicated by better serum markers, DENVER2 scores, and ultrasound findings (P < 0.05).
- Intensive insulin therapy alleviated post-burn insulin resistance, reduced the catabolic response, and dampened inflammation (P < 0.05).
Conclusions:
- Intensive insulin therapy significantly improves post-burn morbidity in severely burned pediatric patients.
- The study demonstrates benefits in reducing infections, enhancing organ function, and managing metabolic and inflammatory responses.
- Further research may explore the impact on mortality, though not statistically significant in this trial (P = 0.14).
Rationale:
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.
Objectives:
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).
Measurements And Main 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).
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