Insulin Therapy in the ICU

The authors from Catholic University of Leuven, Belgium performed a prospective, randomized, controlled study of intensive versus conventional glucose control among adult patients admitted to a medical intensive care unit (ICU) who at the time of admission were expected to need ICU care for at least 3 days and who did not have advance directives limiting their care. The intensive treatment group received insulin when their blood glucose levels exceeded 110 mg/dL with a targeted glucose range of 80–110 mg/dL. The conventional treatment group received insulin when their blood glucose exceeded 215 mg/dL with a targeted glucose range of 180–200 mg/dL. Glucose was managed using a paper-based protocol previously reported,¹ and enteral feeding was directed by care guidelines.

Patients with diabetes were eligible for study and constituted 16.9% of patients. In-hospital mortality was the primary outcome while ICU mortality, days of mechanical ventilation, new kidney injury (defined as a doubling of serum creatinine or peak creatinine of >2.5 mg/dL), and the need for dialysis were secondary outcomes. Hypoglycemia was defined as a glucose level <40 mg/dL.

Between March 2002 and May 2005, 1200 patients were enrolled, 605 in …