A comparative study of efficacy of Intensive Insulin Therapy versus conventional method on mortality and morbidity of critically ill patients

Abstract

Objective: Hyperglycemia is associated with increased mortality and morbidity. Current evidence has controversies about Intensive Insulin Therapy (IIT) and its effect on reducing mortality in critically ill patients. In this trial we evaluated the effect of intensive insulin therapy with a simple protocol versus traditional method on morbidity and mortality of critically ill patients who were admitted to surgical intensive care unit. Methodology: Sixty adult patients admitted to surgical intensive care unit between Feb 2009 to Feb 2010 in Shohada Hospital, were enrolled in this study. Patients were randomly allocated to intensive insulin therapy group (with a target blood sugar of 80-120 mg/dl) and conventional group (received insulin if blood glucose was more than 200 mg/dl). Study was continued through the ICU stay of all patients. Results: Acute Kidney Injury, Renal Replacement Therapy, Bactremia and transfusion were less in intensive insulin therapy without significant difference compared to control group. Mortality also was not significant between two groups. Conclusion: Because of the consequences of hyperglycemia, IIT might be considered in critically ill patients, but intermediate levels may be more safe and effective and remains the best practice in Intensive Care Units. Defining ICU capability is critical for implementing tight glycemic control and future multi center studies are needed to consider the effect of IIT on mortality as an essential outcome.