The Pharmaceutical Journal Vol 267 No 7174 p701-706
17 November 2001

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Tight control of glucose beneficial in ICU patients

Tight control of blood glucose levels reduces mortality among intensive care patients, a study has found.

Professor Greet Van den Berghe, University of Leuven, Belgium, and colleagues investigated the effect of intensive insulin therapy and conventional treatment in 1,548 patients admitted to intensive care units (ICU). Intensive therapy consisted of insulin infusion being started if the blood glucose level exceeded 6.1mmol/L and adjusted to maintain the level between 4.4 and 6.1mmol/L. In the conventional treatment regimen, insulin was started if the blood glucose level exceeded 12mmol/L and adjusted to maintain it between 10.0 and 11.1mmol/L.

In the intensive treatment group, 4.6 per cent of patients died compared with 8.0 per cent of the conventional treatment group, representing, after adjustment, an unbiased risk reduction of 32 per cent. Intensive treatment also reduced the incidence of complications such as septicemia, acute renal failure and critical illness polyneuropathy.

The researchers comment that hyperglycaemia and insulin resistance are common in critically ill patients even if they have not previously had diabetes. This study demonstrated that hyperglycaemia is not beneficial and should be treated with intensive insulin therapy, regardless of whether the patient had a previous diagnosis of diabetes (New England Journal of Medicine (2001;345:1359).

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