Proinflammatory effects of glucose and anti-inflammatory effect of insulin: relevance to cardiovascular disease.

Previously published data demonstrate clearly that hyperglycemia worsens morbidity and mortality in patients in intensive care, those with acute myocardial infarction and stroke, and those who undergo coronary artery bypass grafting. The control of hyperglycemia with insulin infusion improves clinical outcomes in all these classes of patients. In this report, the investigators discuss data demonstrating an anti-inflammatory effect of insulin and a proinflammatory effect of glucose and free fatty acids and provide a mechanistic justification for the benefits of maintaining euglycemia with insulin infusions in hospitalized patients. The regimens that infuse fixed doses of insulin with high rates of glucose are usually associated with hyperglycemia. This may neutralize the beneficial effects of insulin. Such regimens should therefore be avoided in the future and replaced by regimens that infuse insulin to restore and maintain euglycemia.