Intensive insulin therapy in the intensive care unit: update on clinical impact and mechanisms of action.

OBJECTIVE: Hyperglycemia is a common feature of the critically ill and has been associated with increased mortality. In this review, we give an overview of studies associating critical illness-induced hyperglycemia with adverse outcome and describe how mortality and morbidity are affected when blood glucose levels are strictly controlled to normoglycemia with intensive insulin therapy.
RESULTS: Maintaining normoglycemia with intensive insulin therapy improves survival rates and reduces morbidity in prolonged critically ill patients in both surgical and medical intensive care units (ICUs), as shown by 2 large randomized controlled studies. Prevention of cellular glucose toxicity by strict glycemic control appears to play a predominant role, but other metabolic and nonmetabolic effects of insulin also seem to contribute to the clinical benefits of this therapy.
CONCLUSION: These data support the generalized implementation of a strict blood glucose control management with intensive insulin therapy in adult surgical as well as medical ICU patients.