Michelle A. Kovalaske, MD; Gunjan Y. Gandhi, MD, MSc
How does intensive insulin therapy affect risk for mortality and hypoglycemia in critically ill adults?
Included studies compared intensive insulin therapy (target blood glucose level ≤ 8.3 mmol/L [150 mg/dL]) with conventional glucose management in adults in critical care settings and reported mortality. Trials had to be published in full or as abstracts in indexed journals. Outcomes were mortality and hypoglycemic events (blood glucose level ≤ 2.2 mmol/L [40 mg/dL]).
MEDLINE, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials (all to Mar 2008); abstracts from selected conferences (2000 to 2008); and reference lists were searched for randomized controlled trials (RCTs). 26 RCTs (n = 13 657, mean age range 46 to 75 y) met the selection criteria: 5 RCTs were done in surgical settings, 6 in medical settings, and 15 in mixed settings. 16 RCTs had a glucose target ≤ 6.1 mmol/L (110 mg/dL), 9 had a target ≤ 8.3 mmol/L (150 mg/dL), and 1 randomized patients to 1 of 3 glucose targets.
Meta-analysis showed that intensive insulin therapy was not associated with reduced mortality but increased risk for hypoglycemic events (Table). Prespecified subgroup analysis showed that intensive insulin therapy reduced mortality in surgical settings (driven by the results of a large single-center trial); groups did not differ in medical or mixed settings (Table).
In critically ill adults, intensive insulin therapy increases risk for hypoglycemia but does not reduce overall mortality.
Intensive insulin therapy vs conventional glucose management in critically ill adults*
*NS = not significant; other abbreviations defined in Glossary. Weighted event rates, RRR, RRI, NNT, NNH, and CI calculated from data in article using a random-effects model.
†Blood glucose level ≤ 2.2 mmol/L (40 mg/dL).
Michelle A. Kovalaske, Gunjan Y. Gandhi. Review: Intensive insulin therapy increases risk for hypoglycemia but not mortality in critically ill adults. Ann Intern Med. 2009;151:JC2–4. doi: 10.7326/0003-4819-151-4-200908180-02004
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Published: Ann Intern Med. 2009;151(4):JC2-4.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Pulmonary/Critical Care.
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