Mini Review

Insulin Treatment in Intensive Care Patients
Sarah Derde, Ilse Vanhorebeek, Greet Van den Berghe

Department of Intensive Care Medicine, Katholieke Universiteit Leuven, Leuven, Belgium

Address of Corresponding Author

Horm Res 2009;71:2-11 (DOI: 10.1159/000173736)

  Key Words

• Critical illness
• Hyperglycemia
• Hypoglycemia
• Insulin
• Metabolism

  Abstract

Hyperglycemia is a major risk factor for increased morbidity and mortality in the intensive care unit. In two large randomized controlled single-center studies, the maintenance of strict normoglycemia with intensive insulin therapy has been shown to reduce morbidity and mortality. The benefits were more pronounced with at least a few days of treatment. Several implementation studies confirmed that blood glucose control with intensive insulin therapy is beneficial for critically ill patients. Two studies planned as large randomized controlled trials evaluating the effect of glycemic control in adults were stopped prematurely because of protocol violation and/or increased risk of hypoglycemia. The only multicenter trial designed with sufficient statistical power to assess the impact of strict blood glucose control with intensive insulin therapy on survival of a heterogeneous adult critically ill patient population is still ongoing. While awaiting these results, the current evidence favors strict control of blood glucose levels to normoglycemia below 110 mg/dl. Avoiding glucose toxicity appears crucial to obtain the clinical benefits of this therapy, although direct insulin effects may contribute as well.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

Greet Van den Berghe, MD, PhD
Department of Intensive Care Medicine, University Hospital Gasthuisberg
Herestraat 49, BE-3000 Leuven (Belgium)
Tel. +32 16 344 021, Fax +32 16 344 015
E-Mail greet.vandenberghe@med.kuleuven.be

  Article Information

Received: February 27, 2008
Accepted: August 15, 2008
Published online: November 27, 2008
Number of Print Pages : 10
Number of Figures : 1, Number of Tables : 1, Number of References : 75