ArticleCritical care (London, England)2010
Does intensive insulin therapy really reduce mortality in critically ill surgical patients? A reanalysis of meta-analytic data.
Article in Critical care (London, England), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 7 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
18 citing papers in PubMed, 7 syntheses or guidelines pooled it, 54 citations in OpenAlex.
- Effect of liberal glucose control on critically ill patients: a systematic review and meta-analysis.BMC endocrine disorders · 2025Pooled it
- [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020Guideline
- Sliding scale insulin for non-critically ill hospitalised adults with diabetes mellitus.The Cochrane database of systematic reviews · 2018Pooled it
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.Intensive care medicine · 2017Guideline
- Glycemic control, mortality, and hypoglycemia in critically ill patients: a systematic review and network meta-analysis of randomized controlled trials.Intensive care medicine · 2017Pooled it
- Accuracy of blood-glucose measurements using glucose meters and arterial blood gas analyzers in critically ill adult patients: systematic review.Critical care (London, England) · 2013Pooled it
- Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012.Intensive care medicine · 2013Guideline
- Evaluation of a continuous blood glucose monitoring system using central venous microdialysis.Journal of diabetes science and technology · 2012Trial
- Expert consensus on the glycemic management of critically ill patients.Journal of intensive medicine · 2022Article
- Glycated hemoglobin A1c level on the day of emergency surgery is a marker of premorbid glycemic control: a retrospective observational study.BMC anesthesiology · 2018Observational
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016).Journal of intensive care · 2018Article
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016).Acute medicine & surgery · 2018Article
- Acute glycemic control in diabetics. How sweet is oprimal? Con: Just as sweet as in nondiabetic is better.Journal of intensive care · 2018Review
- Glycemic control in acute illness.Korean journal of anesthesiology · 2017Review
- The optimal target for acute glycemic control in critically ill patients: a network meta-analysis.Intensive care medicine · 2017Review
- Influence of a strict glucose protocol on serum potassium and glucose concentrations and their association with mortality in intensive care patients.Critical care (London, England) · 2015Observational
- The Japanese guidelines for the management of sepsis.Journal of intensive care · 2014Article
- Intensive insulin therapy in critically ill hospitalized patients: making it safe and effective.Journal of diabetes science and technology · 2011Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 3 institutions in 3 countries.
Funding
Abstract
Two recent systematic reviews evaluating intensive insulin therapy (IIT) in critically ill patients grouped randomized controlled trials (RCTs) by type of intensive care unit (ICU). The more recent review found that IIT reduced mortality in patients admitted to a surgical ICU, but not in those admitted to medical ICUs or mixed medical-surgical ICUs, or in all patients combined. Our objective was to determine whether IIT saves lives in critically ill surgical patients regardless of the type of ICU. Pooling mortality data from surgical and medical subgroups in mixed-ICU RCTs (16 trials) with RCTs conducted exclusively in surgical ICUs (five trials) and in medical ICUs (five trials), respectively, showed no effect of IIT in the subgroups of surgical patients (risk ratio = 0.85, 95% confidence interval (CI) = 0.69 to 1.04, P = 0.11; I2 = 51%, 95% CI = 1 to 75%) or of medical patients (risk ratio = 1.02, 95% CI = 0.95 to 1.09, P = 0.61; I2 = 0%, 95% CI = 0 to 41%). There was no differential effect between subgroups (interaction P = 0.10). There was statistical heterogeneity in the surgical subgroup, with some trials demonstrating significant benefit and others demonstrating significant harm, but no surgical subgroup consistently benefited from IIT. Such a reanalysis suggests that IIT does not reduce mortality in critically ill surgical patients or medical patients. Further insights may come from individual patient data meta-analyses or from future large multicenter RCTs in more narrowly defined subgroups of surgical patients.
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Registered trials
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.