Consider The Evidence: Med/Peds Journal Roundup

February 3, 2006

Sugar, Sugar – Gluose control in the MICU

Filed under: critical care, glucose control, NEJM — medblog @ 2:45 am

NEJM 2/2 – Greet Van den Berghe has rocked the world of critical care with her work championing the benefits of intensive blood glucose control. Her latest paper on the subject appears in this weeks New England. And the results are…good. Mabye not quite the blockbuster as some of the earlier work, but
interesting data nonetheless.

The study compares strict glucose control with an insulin infusion protocol to a conventional strategy of administering insulin for a glucose greater than 215. The study found a reduction in morbidity, however, lacked the reduction in mortality shown in earlier studies. Patients in the insulin infusion group had a reduced incidence of new kidney injury, less time to wean ventilation, and shorter ICU stay.

The downside: Not much protection for those with pre-existing kidney disease, and no reduction in occurrence in sepsis as shown in the earlier SICU data.

In the post-hoc analysis (aka trolling for more positive outcomes), there was a significant reduction in mortality in those with ICU stays longer than three days – so maybe this is a somewhat time related effect. Clearly fodder for some good follow-up studies.

Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006;354:449-461

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