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01-04-2008 | Review

Pro/con debate: Is intensive insulin therapy targeting tight blood glucose control of benefit in critically ill patients?

Authors: Tobias M Merz, Simon Finfer

Published in: Critical Care | Issue 2/2008

Abstract

You have decided to develop a protocol for insulin therapy in your intensive care unit (ICU). You wonder about the merit of using intensive insulin therapy (IIT) to maintain tight blood glucose control in your patients.

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Berghe van den G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001, 345: 1359-1367. 10.1056/NEJMoa011300.PubMedCrossRef

Berghe Van den G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, Van Wijngaerden E, Bobbaers H, Bouillon R: Intensive insulin therapy in the medical ICU. N Engl J Med. 2006, 354: 449-461. 10.1056/NEJMoa052521.PubMedCrossRef

Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K, German Competence Network Sepsis (SepNet): Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008, 358: 125-139. 10.1056/NEJMoa070716.PubMedCrossRef

Lang CH, Dobrescu C, Bagby GJ: Tumor necrosis factor impairs insulin action on peripheral glucose disposal and hepatic glucose output. Endocrinology. 1992, 130: 43-52. 10.1210/en.130.1.43.PubMed

Tappy L, Cayeux MC, Schneiter P, Schindler C, Temler E, Jequier E, Chiolero R: Effects of lactate on glucose metabolism in healthy subjects and in severely injured hyperglycemic patients. Am J Physiol. 1995, 268: E630-635.PubMed

Tappy L, Chiolero R, Berger M: Autoregulation of glucose production in health and disease. Curr Opin Clin Nutr Metab Care. 1999, 2: 161-164. 10.1097/00075197-199903000-00012.PubMedCrossRef

Khani S, Tayek JA: Cortisol increases gluconeogenesis in humans: its role in the metabolic syndrome. Clin Sci (Lond). 2001, 101: 739-747.CrossRef

McCowen KC, Malhotra A, Bistrian BR: Stress-induced hyperglycemia. Crit Care Clin. 2001, 17: 107-124. 10.1016/S0749-0704(05)70154-8.PubMedCrossRef

Gustavson SM, Chu CA, Nishizawa M, Farmer B, Neal D, Yang Y, Donahue EP, Flakoll P, Cherrington AD: Interaction of glucagon and epinephrine in the control of hepatic glucose production in the conscious dog. Am J Physiol Endocrinol Metab. 2003, 284: E695-707.PubMedCrossRef

10.

Rodnick KJ, Piper RC, Slot JW, James DE: Interaction of insulin and exercise on glucose transport in muscle. Diabetes Care. 1992, 15: 1679-1689. 10.2337/diacare.15.11.1679.PubMedCrossRef

11.

Wasserman DH, Geer RJ, Rice DE, Bracy D, Flakoll PJ, Brown LL, Hill JO, Abumrad NN: Interaction of exercise and insulin action in humans. Am J Physiol. 1991, 260: E37-45.PubMed

12.

Quijano C, Castro L, Peluffo G, Valez V, Radi R: Enhanced mitochondrial superoxide in hyperglycemic endothelial cells: direct measurements and formation of hydrogen peroxide and peroxynitrite. Am J Physiol Heart Circ Physiol. 2007, 293: H3404-3414. 10.1152/ajpheart.00761.2007.PubMedCrossRef

13.

Vanhorebeek I, De Vos R, Mesotten D, Wouters PJ, De Wolf-Peeters C, Berghe Van den G: Protection of hepatocyte mitochondrial ultrastructure and function by strict blood glucose control with insulin in critically ill patients. Lancet. 2005, 365: 53-59. 10.1016/S0140-6736(04)17665-4.PubMedCrossRef

14.

Krinsley JS: Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003, 78: 1471-1478.PubMedCrossRef

15.

Yendamuri S, Fulda GJ, Tinkoff GH: Admission hyperglycemia as a prognostic indicator in trauma. J Trauma. 2003, 55: 33-38.PubMedCrossRef

16.

Rovlias A, Kotsou S: The influence of hyperglycemia on neurological outcome in patients with severe head injury. Neurosurgery. 2000, 46: 335-342. 10.1097/00006123-200002000-00015. discussion 342–333.PubMedCrossRef

17.

Leonidou L, Mouzaki A, Michalaki M, DeLastic AL, Kyriazopoulou V, Bassaris HP, Gogos CA: Cytokine production and hospital mortality in patients with sepsis-induced stress hyperglycemia. J Infect. 2007, 55: 340-346. 10.1016/j.jinf.2007.05.177.PubMedCrossRef

18.

Ali NA, O'Brien JM, Blum W, Byrd JC, Klisovic RB, Marcucci G, Phillips G, Marsh CB, Lemeshow S, Grever MR: Hyperglycemia in patients with acute myeloid leukemia is associated with increased hospital mortality. Cancer. 2007, 110: 96-102. 10.1002/cncr.22777.PubMedCrossRef

19.

Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC: Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001, 32: 2426-2432. 10.1161/hs1001.096194.PubMedCrossRef

20.

Capes SE, Hunt D, Malmberg K, Gerstein HC: Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. 2000, 355: 773-778. 10.1016/S0140-6736(99)08415-9.PubMedCrossRef

21.

Malmberg K: Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ. 1997, 314: 1512-1515.PubMedPubMedCentralCrossRef

22.

Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, Raskin P, Zinman B: Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005, 353: 2643-2653. 10.1056/NEJMoa052187.PubMedCrossRef

23.

Pittas AG, Siegel RD, Lau J: Insulin therapy for critically ill hospitalized patients: a meta-analysis of randomized controlled trials. Arch Intern Med. 2004, 164: 2005-2011. 10.1001/archinte.164.18.2005.PubMedCrossRef

24.

Berghe Van den G, Schoonheydt K, Becx P, Bruyninckx F, Wouters PJ: Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology. 2005, 64: 1348-1353.PubMedCrossRef

25.

Hermans G, Wilmer A, Meersseman W, Milants I, Wouters PJ, Bobbaers H, Bruyninckx F, Berghe Van den G: Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit. Am J Respir Crit Care Med. 2007, 175: 480-489. 10.1164/rccm.200605-665OC.PubMedCrossRef

26.

Krinsley JS: Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc. 2004, 79: 992-1000.PubMedCrossRef

27.

Reed CC, Stewart RM, Sherman M, Myers JG, Corneille MG, Larson N, Gerhardt S, Beadle R, Gamboa C, Dent D: Intensive insulin protocol improves glucose control and is associated with a reduction in intensive care unit mortality. J Am Coll Surg. 2007, 204: 1048-1054. 10.1016/j.jamcollsurg.2006.12.047. discussion 1054–1045.PubMedCrossRef

28.

Aragon D: Evaluation of nursing work effort and perceptions about blood glucose testing in tight glycemic control. Am J Crit Care. 2006, 15: 370-377.PubMed

29.

Berghe Van den G, Wouters PJ, Kesteloot K, Hilleman DE: Analysis of healthcare resource utilization with intensive insulin therapy in critically ill patients. Crit Care Med. 2006, 34: 612-616.PubMed

30.

Krinsley JS, Jones RL: Cost analysis of intensive glycemic control in critically ill adult patients. Chest. 2006, 129: 644-650. 10.1378/chest.129.3.644.PubMedCrossRef

31.

Devos P, Preiser JC, Mélot C: Impact of tight glucose control by intensive insulin therapy on ICU mortality and the rate of hypoglycaemia: final results of the Glucontrol study. Intensive Care Med. 2007, 33 (Suppl 2): S189-

32.

Macias WL, Vallet B, Bernard GR, Vincent JL, Laterre PF, Nelson DR, Derchak PA, Dhainaut JF: Sources of variability on the estimate of treatment effect in the PROWESS trial: implications for the design and conduct of future studies in severe sepsis. Crit Care Med. 2004, 32: 2385-2391. 10.1097/01.CCM.0000147440.71142.AC.PubMedCrossRef

33.

Bellomo R, Egi M: Glycemic control in the intensive care unit: why we should wait for NICE-SUGAR. Mayo Clin Proc. 2005, 80: 1546-1548.PubMedCrossRef

34.

Angus DC, Abraham E: Intensive insulin therapy in critical illness. Am J Respir Crit Care Med. 2005, 172: 1358-1359. 10.1164/rccm.2508009.PubMedCrossRef

35.

Wheatley K, Clayton D: Be skeptical about unexpected large apparent treatment effects: the case of an MRC AML12 randomization. Control Clin Trials. 2003, 24: 66-70. 10.1016/S0197-2456(02)00273-8.PubMedCrossRef

36.

Welke KF, Peterson ED, Vaughan-Sarrazin MS, O'Brien SM, Rosenthal GE, Shook GJ, Dokholyan RS, Haan CK, Ferguson TB: Comparison of cardiac surgery volumes and mortality rates between the Society of Thoracic Surgeons and Medicare databases from 1993 through 2001. Ann Thorac Surg. 2007, 84: 1538-1546. 10.1016/j.athoracsur.2007.06.022.PubMedCrossRef

37.

Kalkat MS, Edwards MB, Taylor KM, Bonser RS: Composite aortic valve graft replacement: mortality outcomes in a national registry. Circulation. 2007, 116 (11 Suppl): I301-306.PubMed

38.

Humphries KH, Gao M, Pu A, Lichtenstein S, Thompson CR: Significant improvement in short-term mortality in women undergoing coronary artery bypass surgery (1991 to 2004). J Am Coll Cardiol. 2007, 49: 1552-1558. 10.1016/j.jacc.2006.08.068.PubMedCrossRef

39.

Egi M, Bellomo R, Stachowski E, French CJ, Hart G, Stow P, Li W, Bates S: Intensive insulin therapy in postoperative intensive care unit patients: a decision analysis. Am J Respir Crit Care Med. 2006, 173: 407-413. 10.1164/rccm.200506-961OC.PubMedCrossRef

40.

Berghe Van den G, Wilmer A, Milants I, Wouters PJ, Bouckaert B, Bruyninckx F, Bouillon R, Schetz M: Intensive insulin therapy in mixed medical/surgical intensive care units: benefit versus harm. Diabetes. 2006, 55: 3151-3159. 10.2337/db06-0855.PubMedCrossRef

41.

Mitchell I, Finfer S, Bellomo R, Higlett T: Management of blood glucose in the critically ill in Australia and New Zealand: a practice survey and inception cohort study. Intensive Care Med. 2006, 32: 867-874. 10.1007/s00134-006-0135-4.PubMedCrossRef

42.

Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P: Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr. 2003, 27: 355-373.PubMedCrossRef

43.

Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, Nitenberg G, Berghe van den G, Wernerman J, DGEM (German Society for Nutritional Medicine), Ebner C, Hartl W, Heymann C, Spies C, ESPEN (European Society for Parenteral and Enteral Nutrition): ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr. 2006, 25: 210-223. 10.1016/j.clnu.2006.01.021.PubMedCrossRef

44.

Jolliet P, Pichard C, Biolo G, Chioléro R, Grimble G, Leverve X, Nitenberg G, Novak I, Planas M, Preiser JC, Roth E, Schols AM, Wernerman J: Enteral nutrition in intensive care patients: a practical approach. Working Group on Nutrition and Metabolism, ESICM. European Society of Intensive Care Medicine. Intensive Care Med. 1998, 24: 848-859. 10.1007/s001340050677.PubMedCrossRef

45.

Mueller PS, Montori VM, Bassler D, Koenig BA, Guyatt GH: Ethical issues in stopping randomized trials early because of apparent benefit. Ann Intern Med. 2007, 146: 878-881.PubMedCrossRef

46.

Montori VM, Devereaux PJ, Adhikari NK, Burns KE, Eggert CH, Briel M, Lacchetti C, Leung TW, Darling E, Bryant DM, Bucher HC, Schünemann HJ, Meade MO, Cook DJ, Erwin PJ, Sood A, Sood R, Lo B, Thompson CA, Zhou Q, Mills E, Guyatt GH: Randomized trials stopped early for benefit: a systematic review. JAMA. 2005, 294: 2203-2209. 10.1001/jama.294.17.2203.PubMedCrossRef

47.

Fontanarosa PB, DeAngelis CD: Publication of clinical trials in JAMA: information for authors. JAMA. 2008, 299: 95-96. 10.1001/jama.2007.28.

48.

Vriesendorp TM, van Santen S, DeVries JH, de Jonge E, Rosendaal FR, Schultz MJ, Hoekstra JB: Predisposing factors for hypoglycemia in the intensive care unit. Crit Care Med. 2006, 34: 96-101. 10.1097/01.CCM.0000194536.89694.06.PubMedCrossRef

49.

Arabi Y, Tamim H, Alshimemeri A, Memish Z, Junaid S, Rishu A, Daker M, Haddad S, Kahoul S, Britts R, Sakkijha M: Intensive versus standard insulin therapy: a randomized controlled trial in medical surgical critically ill patients. Crit Care Med. 2006, 34: A65-10.1097/00003246-200612002-00227.CrossRef

50.

Collins R, MacMahon S: Reliable assessment of the effects of treatment on mortality and major morbidity, I: clinical trials. Lancet. 2001, 357: 373-380. 10.1016/S0140-6736(00)03651-5.PubMedCrossRef

51.

Krinsley JS, Grover A: Severe hypoglycemia in critically ill patients: risk factors and outcomes. Crit Care Med. 2007, 35: 2262-2267.PubMedCrossRef

52.

Vriesendorp TM, DeVries JH, van Santen S, Moeniralam HS, de Jonge E, Roos YB, Schultz MJ, Rosendaal FR, Hoekstra JB: Evaluation of short-term consequences of hypoglycemia in an intensive care unit. Crit Care Med. 2006, 34: 2714-2718. 10.1097/01.CCM.0000241155.36689.91.PubMedCrossRef

Title: Pro/con debate: Is intensive insulin therapy targeting tight blood glucose control of benefit in critically ill patients?
Authors: Tobias M Merz
Simon Finfer
Publication date: 01-04-2008
Publisher: BioMed Central
Published in: Critical Care / Issue 2/2008
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc6837

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pro/con debate: Is intensive insulin therapy targeting tight blood glucose control of benefit in critically ill patients?

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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