Tight Control of Glucose Reduces ICU Mortality 42%

Compared to standard therapy with insulin, intensive insulin reduced ICU mortality by 42%. The study was published in the November 8, 2001, issue of The New England Journal of Medicine.

Other studies have linked chronically high blood glucose levels to morbidity and mortality in diabetics, but experts have been uncertain whether hyperglycemia in previously nondiabetic ICU patients was part of a beneficial adaptation to stress or a disturbance that should be more strictly monitored. The researchers' goal was to learn whether maintaining blood glucose levels closer to normal would benefit ICU patients.

The prospective, randomized controlled study involved 1,548 critically ill adult patients admitted to the ICU and on mechanical ventilatory support. The patients received a regular, human insulin injection (of recombinant DNA origin) and were placed on either an intensive regimen to maintain blood glucose in the normal range (80-110 mg/dl) or standard treatment to maintain blood glucose at 180-216 mg/dl. After analysis revealed such a marked benefit for the intensive regimen, the study was discontinued for ethical reasons. The mortality reduction of 42% for the intensive therapy group occurred only in long-stay patients and was due to the prevention of lethal multiple organ failure caused by severe infections, say the researchers. The intensive therapy also reduced length of ICU stay, incidence of bacterimia, hemodialysis, and prolonged ventilatory support.

The insulin used in the study was Actrapid HM, from Novo Nordisk (Bagsvaerd, Denmark).



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