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American Academy of Pediatrics
CRITICAL CARE

Insulin Therapy in the ICU

AAP Grand Rounds June 2006, 15 (6) 73-74; DOI: https://doi.org/10.1542/gr.15-6-73
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Source: Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354:449–461; doi:10.1056/NEJMoa052521OpenUrlCrossRefPubMed

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 …

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AAP Grand Rounds
Vol. 15, Issue 6
1 Jun 2006
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Insulin Therapy in the ICU
AAP Grand Rounds Jun 2006, 15 (6) 73-74; DOI: 10.1542/gr.15-6-73

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