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Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy?
Crit Care. 2009; 13(2):302.CC

Abstract

Since the first report that intensive insulin therapy reduced mortality in selected surgical critically ill patients, lowering of blood glucose levels has been recommended as a means of improving patient outcomes. In this initial Leuven trial, blood glucose control by protocol using insulin was applied to 98.7% of patients in the intensive group but to only 39.2% (P < 0.0001) of patients in the control group. If appropriately applied, such protocols should decrease both the mean blood glucose concentration and its variability (variation of blood glucose concentration). Thus, it is logically possible that the benefit of intensive insulin therapy in the first Leuven trial was due to a decrease in mean glucose levels, a decrease in their variability, or both. Several recent studies have confirmed significant associations between variability of blood glucose levels and patient outcomes. Decreasing the variability of blood glucose levels might be an important dimension of glucose management, a possible mechanism by which an intensive insulin protocol exerts its putative beneficial effects, and an important goal of glucose management in the intensive care unit. Clinicians need to be aware of this controversy when considering the application of intensive insulin therapy and interpreting future trials.

Authors+Show Affiliations

Department of Anesthesiology and Resuscitology, Okayama University Hospital, Shikata City, Japan 700-8558.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19435472

Citation

Egi, Moritoki, et al. "Is Reducing Variability of Blood Glucose the Real but Hidden Target of Intensive Insulin Therapy?" Critical Care (London, England), vol. 13, no. 2, 2009, p. 302.
Egi M, Bellomo R, Reade MC. Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy? Crit Care. 2009;13(2):302.
Egi, M., Bellomo, R., & Reade, M. C. (2009). Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy? Critical Care (London, England), 13(2), 302. https://doi.org/10.1186/cc7755
Egi M, Bellomo R, Reade MC. Is Reducing Variability of Blood Glucose the Real but Hidden Target of Intensive Insulin Therapy. Crit Care. 2009;13(2):302. PubMed PMID: 19435472.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy? AU - Egi,Moritoki, AU - Bellomo,Rinaldo, AU - Reade,Michael C, Y1 - 2009/04/06/ PY - 2009/5/14/entrez PY - 2009/5/14/pubmed PY - 2009/9/9/medline SP - 302 EP - 302 JF - Critical care (London, England) JO - Crit Care VL - 13 IS - 2 N2 - Since the first report that intensive insulin therapy reduced mortality in selected surgical critically ill patients, lowering of blood glucose levels has been recommended as a means of improving patient outcomes. In this initial Leuven trial, blood glucose control by protocol using insulin was applied to 98.7% of patients in the intensive group but to only 39.2% (P < 0.0001) of patients in the control group. If appropriately applied, such protocols should decrease both the mean blood glucose concentration and its variability (variation of blood glucose concentration). Thus, it is logically possible that the benefit of intensive insulin therapy in the first Leuven trial was due to a decrease in mean glucose levels, a decrease in their variability, or both. Several recent studies have confirmed significant associations between variability of blood glucose levels and patient outcomes. Decreasing the variability of blood glucose levels might be an important dimension of glucose management, a possible mechanism by which an intensive insulin protocol exerts its putative beneficial effects, and an important goal of glucose management in the intensive care unit. Clinicians need to be aware of this controversy when considering the application of intensive insulin therapy and interpreting future trials. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/19435472/Is_reducing_variability_of_blood_glucose_the_real_but_hidden_target_of_intensive_insulin_therapy L2 - https://ccforum.biomedcentral.com/articles/10.1186/cc7755 DB - PRIME DP - Unbound Medicine ER -