Insulin‐based regimens decrease mortality rates in critically ill patients: a systematic review

Abstract

SummaryObjectives To determine whether treatment with glucose-insulin-potassium (GIK), insulin and glucose, or insulin by itself is beneficial in limiting organ damage after acute myocardial infarction (AMI) and reducing mortality and morbidity among critically ill hyperglycaemic patients.Methods Systematic review of randomized controlled trials.Main outcome measure To assess whether tight glycaemic control reduces morbidity and mortality. Studies reviewed Randomized controlled trials of insulin-based regimens in the treatment of critically ill patients.Results Nine hundred and twenty-four potentially relevant studies were identified and screened for retrieval. Of these, 16 randomized controlled trials met the inclusion criteria (Table 1). Ten studies examined the effects of GIK, and six of these studies reported a mortality reduction with GIK treatment in addition to enhanced myocardial performance. Five studies examined the administration of insulin. Among these studies, tight glycaemic control of blood glucose in one study was shown to reduce morbidity and mortality of patients in intensive care. Only one study examined insulin/glucose therapy, and it showed a post-myocardial infarction mortality reduction of one year.Conclusions There is increasing evidence that maintaining normoglycaemia and treatment with insulin-based regimens is beneficial in limiting organ damage and significantly reduces both morbidity and mortality in critically ill patients who require intensive care therapy.

Intensive Versus Intermediate Glucose Control in Surgical Intensive Care Unit Patients

“…Because all of the scheduled patients were recruited in the current study, the mortality rate was very low and acceptable compared with previous large studies (25). Of course, limitations of our trial include the use of a subjective criterion the same as previous reviews and metaanalysis describing bias, chance, and atypical clinical practices (7)(8)(9). Although our trial was not blinded, which could lead to bias, postoperative calorie administration and surgical managements were matched in both groups by the same staff at our single center.…”

Insulin-induced myocardial protection in isolated ischemic rat hearts requires p38 MAPK phosphorylation of Hsp27

“…During ischemia, the components of GIK favor a shift from the anaerobic free fatty acid metabolism with generation of toxic fatty acyl-CoA to the less toxic anaerobic glucose-dependent metabolism and facilitates glycolysis to produce more energy. Most clinical studies suggest GIK reduces both morbidity and mortality (67,38). However, some studies show that GIK is of minimal benefit (9,51).…”

Treatment with insulin inhibits poly(ADP-ribose)polymerase activation in a rat model of endotoxemia

“…Intensive insulin treatment reduced the number of deaths from multiple organ failure with sepsis. Markers of inflammation were found to be less frequently abnormal in the intensive insulin treatment group than in the conventional treatment group (Ellger et al, 2006;Langley and Adams, 2007). Although a number of outstanding issues remain to be addressed with this concept, and the degree of benefit that normalization of circulating glucose offers may be different in different groups of patients (Preiser and Devos, 2007;Vanhorebeek et al, 2007;Nazer et al, 2007), intensive glucose control emerges as a potential therapeutic tool for critically ill patients.…”