ArticleCritical care (London, England)2008
Intensive insulin therapy and mortality in critically ill patients.
Article in Critical care (London, England), 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 6 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
38 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Pooled it
- Pooled it
- Energy, Protein, Carbohydrate, and Lipid Intakes and Their Effects on Morbidity and Mortality in Critically Ill Adult Patients: A Systematic Review.Advances in nutrition (Bethesda, Md.) · 2017Pooled it
- Guideline
- Guideline
- Systematic review: comparative effectiveness and safety of premixed insulin analogues in type 2 diabetes.Annals of internal medicine · 2008Pooled it
- Pilot study of the SPRINT glycemic control protocol in a Hungarian medical intensive care unit.Journal of diabetes science and technology · 2012Trial
- Effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing gastrectomy.World journal of gastroenterology · 2012Trial
- Clinical effects of intensive insulin therapy treating traumatic shock combined with multiple organ dysfunction syndrome.Journal of Huazhong University of Science and Technology. Medical sciences = Hua zhong ke ji da xue xue bao. Yi xue Ying De wen ban = Huazhong keji daxue xuebao. Yixue Yingdewen ban · 2011Trial
- A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study.Intensive care medicine · 2009Trial
- Comparison of three protocols for tight glycemic control in cardiac surgery patients.Diabetes care · 2009Trial
- Hyperglycemia in Pet African Pygmy Hedgehogs (Animals : an open access journal from MDPI · 2025Article
- Between blood glucose and mortality in critically ill patients: Retrospective analysis of the MIMIC-IV database.Journal of diabetes investigation · 2024Article
- Mean Blood Glucose Level During ICU Hospitalization is a Strong Predictor of the Mortality of COVID-19.Diabetes, metabolic syndrome and obesity : targets and therapy · 2024Article
- 3D kernel-density stochastic model for more personalized glycaemic control: development and in-silico validation.Biomedical engineering online · 2019Article
- Nutrition delivery of a model-based ICU glycaemic control system.Annals of intensive care · 2018Article
- Untangling glycaemia and mortality in critical care.Critical care (London, England) · 2017Article
- Strict glycemic control to prevent surgical site infections in gastroenterological surgery.Annals of gastroenterological surgery · 2017Review
- Safety, efficacy and clinical generalization of the STAR protocol: a retrospective analysis.Annals of intensive care · 2016Article
- Predisposing Factors for Hypoglycemia and Its Relation With Mortality in Critically Ill Patients Undergoing Insulin Therapy in an Intensive Care Unit.Anesthesiology and pain medicine · 2016Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIntensive insulin therapy (IIT) with tight glycemic control may reduce mortality and morbidity in critically ill patients and has been widely adopted in practice throughout the world. However, there is only one randomized controlled trial showing unequivocal benefit to this approach and that study population was dominated by post-cardiac surgery patients. We aimed to determine the association between IIT and mortality in a mixed population of critically ill patients.
methodsWe conducted a cohort study comparing three consecutive time periods before and after IIT protocol implementation in a Level 1 trauma center: period I (no protocol); period II, target glucose 80 to 130 mg/dL; and period III, target glucose 80 to 110 mg/dL. Subjects were 10,456 patients admitted to intensive care units (ICUs) between 1 March 2001 and 28 February 2005. The main study endpoints were ICU and hospital mortality, Sequential Organ Failure Assessment score, and occurrence of hypoglycemia. Multivariable regression analysis was used to evaluate mortality and organ dysfunction during periods II and III relative to period I.
resultsInsulin administration increased over time (9% period I, 25% period II, and 42% period III). Nonetheless, patients in period III had a tendency toward higher adjusted hospital mortality (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.98, 1.35) than patients in period I. Excess hospital mortality in period III was present primarily in patients with an ICU length of stay of 3 days or less (OR 1.47, 95% CI 1.11, 1.93 There was an approximately fourfold increase in the incidence of hypoglycemia from periods I to III.
conclusionA policy of IIT in a group of ICUs from a single institution was not associated with a decrease in hospital mortality. These results, combined with the findings from several recent randomized trials, suggest that further study is needed prior to widespread implementation of IIT in critically ill patients.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.