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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...
Autores principales: | , , |
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Formato: | Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2009
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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 |
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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 |
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