Strict glycaemic control in patients hospitalised in a mixed medical and surgical intensive care unit: A randomised clinical trial

Gisela Del Carmen De La Rosa, Jorge Hernando Donado, Alvaro Humberto Restrepo, Alvaro Mauricio Quintero, Luis Gabriel González, Nora Elena Saldarriaga, Marisol Bedoya, Juan Manuel Toro, Jorge Byron Velásquez, Juan Carlos Valencia, Clara Maria Arango, Pablo Henrique Aleman, Esdras Martin Vasquez, Juan Carlos Chavarriaga, Andrés Yepes, William Pulido, Carlos Alberto Cadavid

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Abstract

Introduction: Critically ill patients can develop hyperglycaemia even if they do not have diabetes. Intensive insulin therapy decreases morbidity and mortality rates in patients in a surgical intensive care unit (ICU) and decreases morbidity in patients in a medical ICU. The effect of this therapy on patients in a mixed medical/surgical ICU is unknown. Our goal was to assess whether the effect of intensive insulin therapy, compared with standard therapy, decreases morbidity and mortality in patients hospitalised in a mixed ICU. Methods: This is a prospective, randomised, non-blinded, single-centre clinical trial in a medical/surgical ICU. Patients were randomly assigned to receive either intensive insulin therapy to maintain glucose levels between 80 and 110 mg/dl (4.4 to 6.1 mmol/l) or standard insulin therapy to maintain glucose levels between 180 and 200 mg/dl (10 and 11.1 mmol/l). The primary end point was mortality at 28 days. Results: Over a period of 30 months, 504 patients were enrolled. The 28-day mortality rate was 32.4% (81 of 250) in the standard insulin therapy group and 36.6% (93 of 254) in the intensive insulin therapy group (Relative Risk [RR]: 1.1; 95% confidence interval [CI]: 0.85 to 1.42). The ICU mortality in the standard insulin therapy group was 31.2% (78 of 250) and 33.1% (84 of 254) in the intensive insulin therapy group (RR: 1.06; 95%CI: 0.82 to 1.36). There was no statistically significant reduction in the rate of ICU-acquired infections: 33.2% in the standard insulin therapy group compared with 27.17% in the intensive insulin therapy group (RR: 0.82; 95%CI: 0.63 to 1.07). The rate of hypoglycaemia (≤ 40 mg/dl) was 1.7% in the standard insulin therapy group and 8.5% in the intensive insulin therapy group (RR: 5.04; 95% CI: 1.20 to 21.12). Conclusions: IIT used to maintain glucose levels within normal limits did not reduce morbidity or mortality of patients admitted to a mixed medical/surgical ICU. Furthermore, this therapy increased the risk of hypoglycaemia.

Original languageEnglish
Article numberR120
JournalCritical Care
Volume12
Issue number5
DOIs
StatePublished - 17 Sep 2008
Externally publishedYes

Bibliographical note

Funding Information:
Financial support came from the Instituto Colombiano para el desarrollo de la Ciencia y la Tecnología 'Francisco Jose de Caldas' (COLCIEN-CIAS), Grant: 4374-04-13013. (Bogota, Colombia) and Hospital Pablo Tobon Uribe (Medellin, Colombia).

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