Cargando…

Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy?

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 appl...

Descripción completa

Detalles Bibliográficos
Autores principales: Egi, Moritoki, Bellomo, Rinaldo, Reade, Michael C
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689479/
https://www.ncbi.nlm.nih.gov/pubmed/19435472
http://dx.doi.org/10.1186/cc7755
_version_ 1782167800651972608
author Egi, Moritoki
Bellomo, Rinaldo
Reade, Michael C
author_facet Egi, Moritoki
Bellomo, Rinaldo
Reade, Michael C
author_sort Egi, Moritoki
collection PubMed
description 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.
format Text
id pubmed-2689479
institution National Center for Biotechnology Information
language English
publishDate 2009
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-26894792010-04-06 Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy? Egi, Moritoki Bellomo, Rinaldo Reade, Michael C Crit Care Viewpoint 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. BioMed Central 2009 2009-04-06 /pmc/articles/PMC2689479/ /pubmed/19435472 http://dx.doi.org/10.1186/cc7755 Text en Copyright © 2009 BioMed Central Ltd
spellingShingle Viewpoint
Egi, Moritoki
Bellomo, Rinaldo
Reade, Michael C
Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy?
title Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy?
title_full Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy?
title_fullStr Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy?
title_full_unstemmed Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy?
title_short Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy?
title_sort is reducing variability of blood glucose the real but hidden target of intensive insulin therapy?
topic Viewpoint
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689479/
https://www.ncbi.nlm.nih.gov/pubmed/19435472
http://dx.doi.org/10.1186/cc7755
work_keys_str_mv AT egimoritoki isreducingvariabilityofbloodglucosetherealbuthiddentargetofintensiveinsulintherapy
AT bellomorinaldo isreducingvariabilityofbloodglucosetherealbuthiddentargetofintensiveinsulintherapy
AT reademichaelc isreducingvariabilityofbloodglucosetherealbuthiddentargetofintensiveinsulintherapy