BACKGROUND: Intensive insulin therapy and degree of glycemic control in critically ill patients remains controversial, particularly in patients with diabetes mellitus. We hypothesized that diabetic patients who achieved tight glucose control with continuous insulin therapy would have less morbidity and lower mortality than diabetic patients with uncontrolled blood glucose. METHOD: A retrospective chart review was performed on 395 intensive care unit (ICU) patients that included 235 diabetic patients. All patients received an intravenous insulin protocol targeted to a blood glucose (BG) level of 80-140 mg/dl. Outcomes were compared between (a) nondiabetic and diabetic patients, (b) diabetic patients with controlled BG levels (80-140 mg/dl) versus uncontrolled levels (>140 mg/dl), and (c) diabetic survivors and nonsurvivors. RESULTS: Diabetic patients had a shorter ICU stay compared to nondiabetic patients (10 ± 0.7 vs 13 ± 1.1, p = .01). The mean BG of the diabetic patients was 25% higher on average in the uncontrolled group than in the controlled (166 ± 26 vs 130 ± 9.4 mg/dl, p < .01). There was no difference in ICU and hospital length of stay (LOS) between diabetic patients who were well controlled compared to those who were uncontrolled. Diabetic nonsurvivors had a significantly higher incidence of hypoglycemia (BG <60 mg/dl) compared to diabetic survivors. CONCLUSION: The results showed that a diagnosis of diabetes was not an independent predictor of mortality, and that diabetic patients who were uncontrolled did not have worse outcomes. Diabetic nonsurvivors were associated with a greater amount of hypoglycemic episodes, suggesting these patients may benefit from a more lenient blood glucose protocol.
BACKGROUND: Intensive insulin therapy and degree of glycemic control in critically illpatients remains controversial, particularly in patients with diabetes mellitus. We hypothesized that diabeticpatients who achieved tight glucose control with continuous insulin therapy would have less morbidity and lower mortality than diabeticpatients with uncontrolled blood glucose. METHOD: A retrospective chart review was performed on 395 intensive care unit (ICU) patients that included 235 diabeticpatients. All patients received an intravenous insulin protocol targeted to a blood glucose (BG) level of 80-140 mg/dl. Outcomes were compared between (a) nondiabetic and diabeticpatients, (b) diabeticpatients with controlled BG levels (80-140 mg/dl) versus uncontrolled levels (>140 mg/dl), and (c) diabetic survivors and nonsurvivors. RESULTS:Diabeticpatients had a shorter ICU stay compared to nondiabetic patients (10 ± 0.7 vs 13 ± 1.1, p = .01). The mean BG of the diabeticpatients was 25% higher on average in the uncontrolled group than in the controlled (166 ± 26 vs 130 ± 9.4 mg/dl, p < .01). There was no difference in ICU and hospital length of stay (LOS) between diabeticpatients who were well controlled compared to those who were uncontrolled. Diabetic nonsurvivors had a significantly higher incidence of hypoglycemia (BG <60 mg/dl) compared to diabetic survivors. CONCLUSION: The results showed that a diagnosis of diabetes was not an independent predictor of mortality, and that diabeticpatients who were uncontrolled did not have worse outcomes. Diabetic nonsurvivors were associated with a greater amount of hypoglycemic episodes, suggesting these patients may benefit from a more lenient blood glucose protocol.
Authors: G van den Berghe; P Wouters; F Weekers; C Verwaest; F Bruyninckx; M Schetz; D Vlasselaers; P Ferdinande; P Lauwers; R Bouillon Journal: N Engl J Med Date: 2001-11-08 Impact factor: 91.245
Authors: Moritoki Egi; Rinaldo Bellomo; Edward Stachowski; Craig J French; Graeme K Hart; Gopal Taori; Colin Hegarty; Michael Bailey Journal: Crit Care Med Date: 2011-01 Impact factor: 7.598
Authors: M Morigi; S Angioletti; B Imberti; R Donadelli; G Micheletti; M Figliuzzi; A Remuzzi; C Zoja; G Remuzzi Journal: J Clin Invest Date: 1998-05-01 Impact factor: 14.808
Authors: Philip A Goldberg; Mark D Siegel; Robert S Sherwin; Joshua I Halickman; Michelle Lee; Valerie A Bailey; Sandy L Lee; James D Dziura; Silvio E Inzucchi Journal: Diabetes Care Date: 2004-02 Impact factor: 19.112