Endocrinology in critical care · Glycaemic control in critical illness
Intensive insulin therapy in the medical ICU
| Design | Single-centre randomised controlled trial |
|---|---|
| Treatment | Intensive insulin therapy targeting normoglycaemia |
| Control | Conventional insulin therapy |
| Population | 1200 patients in a medical intensive care unit |
| Follow-up | Hospital discharge |
| Primary endpoint | In-hospital mortality |
| Result | In the intention-to-treat analysis, intensive insulin therapy reduced blood glucose levels but did not significantly reduce in-hospital mortality (40.0% in the conventional group). Morbidity was significantly reduced, and benefit was seen in patients staying three days or more. |
| Secondary endpoints | Newly acquired kidney injury, duration of ventilation, ICU stay, hypoglycaemia |
Intensive insulin therapy significantly reduced morbidity but not mortality among all patients in the medical ICU. Although the risk of subsequent death and disease was reduced in patients treated for three or more days, these patients could not be identified before therapy.
The trial authors, in the published abstract
The authors' own caveat is the crux: the benefit appeared only in patients who stayed three days, and there was no way to know in advance who they would be. The practice it launched was then shown to be lethal at scale by NICE-SUGAR.
Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006 Feb 2;354(5):449-61.