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Insulin Treatments for Septic Shock Compared

Study finds no significant mortality differences among four alternative therapy groups

TUESDAY, Jan. 26 (HealthDay News) -- Among septic shock patients treated with hydrocortisone, intensive insulin therapy did not improve mortality compared to conventional insulin therapy, with or without the further addition of fludrocortisone, according to a study in the Jan. 27 Journal of the American Medical Association.

Djillali Annane, M.D., of the Assistance Publique Hôpitaux de Paris, and colleagues randomly assigned 509 patients with septic shock who had received hydrocortisone treatment to one of four treatment groups: continuous, intensive intravenous insulin infusion with hydrocortisone; continuous, intensive intravenous insulin infusion with hydrocortisone plus fludrocortisone; conventional insulin therapy with hydrocortisone; or conventional insulin therapy with intravenous hydrocortisone plus fludrocortisone. The primary study outcome was in-hospital mortality.

The researchers found that similar proportions of patients died in the groups receiving both the intensive and conventional insulin therapies: 45.9 percent of the 255 patients receiving intensive insulin and 42.9 percent of the 254 receiving conventional insulin. Patients in the intensive insulin group had more episodes of severe hypoglycemia (less than 40 mg/dL) than the group receiving conventional insulin therapy. Of the 245 patients receiving fludrocortisone plus hydrocortisone, 42.9 percent died; and of the 264 patients receiving hydrocortisone alone, 45.8 percent died.

"The overall conclusions of this trial were that among patients with hydrocortisone-treated septic shock, intensive insulin therapy targeting normoglycemia compared with usual care did not improve in-hospital mortality and that compared with use of hydrocortisone alone, the addition of fludrocortisone did not improve in-hospital mortality," writes the author of an accompanying editorial.

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