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Intensive Insulin Therapy May Reduce ICU Deaths

Mortality unaffected in diabetics or those in the intensive care unit for short periods

FRIDAY, Nov. 3 (HealthDay News) -- Intensive insulin therapy reduces mortality in patients in the intensive care unit (ICU), except for those with diabetes or those staying in the ICU for short periods, according to a report in the November issue of Diabetes.

Greet Van den Berghe, M.D., Ph.D., and colleagues from the Catholic University of Leuven in Belgium, pooled data from two randomized controlled trials of patients admitted to the ICU. A total of 2,748 patients were in the intention-to-treat group, 1,389 patients were in the ICU at least three days (long stayers), and 1,359 patients were in the ICU less than three days (short stayers).

Within each group, patients were randomly assigned to conventional treatment, in which insulin was given when blood glucose exceeded 215 mg/dL and maintained at 180-200 mg/dL, or intensive insulin treatment, in which insulin was given when blood glucose exceeded 110 mg/dL and maintained at 80-110 mg/dL.

Intensive insulin reduced mortality in the intention-to-treat group and the long stayers, but had no effect on short stayers or patients with diabetes. Mortality was higher in patients with high blood glucose (more than 150 mg/dL) and lower in those with low blood glucose (less than 110 mg/dL). Maintaining blood glucose at less than 110 mg/dL prevented kidney injury and critical illness polyneuropathy but increased the risk of hypoglycemia, according to the report.

"We conclude that intensive insulin therapy reduces mortality of all medical/surgical ICU patients, except those with a prior history of diabetes, and does not cause harm," Van den Berghe and colleagues conclude. "A blood glucose target less than 110 mg/dL was most effective but also carried the highest risk of hypoglycemia."

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