Diabetes Treatment Review

Intensive insulin therapy in hospitalized patients

Martin Gilmour of the Diabetic Hypoglycemia Editorial Team

Diabetic Hypoglycemia September 2009, Volume 2, Issue 2: page 22-24

Abstract

Hyperglycemia is a stress response to critical illness and is often observed in patients in the intensive care unit (ICU). Intensive insulin therapy can therefore be used in ICU patients to combat associated morbidity and mortality. This treatment review focuses on intensive insulin therapy and its effects on mortality and hypoglycemia in hospitalized patients. Three papers are reviewed; the first is an analysis of data from the recent NICE-SUGAR (Normoglycemia in Intensive Care Evaluation — Survival Using Glucose Algorithm Regulation) study, while the second reviews intensive insulin therapy in the ICU, including the NICE-SUGAR study data. The third describes the mortality risk associated with both spontaneous and iatrogenic hypoglycemia in patients hospitalized with acute myocardial infarction (AMI).

The NICE-SUGAR studies concluded that intensive insulin therapy carried no overall benefits to critically ill patients, and in some cases actually increased mortality by promoting hypoglycemia, but conceded that it may be beneficial in surgical ICU patients. The final study concluded, however, that no increased mortality risk was associated with iatrogenic hypoglycemia following insulin therapy in hospitalized AMI patients. A statement by the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) on the NICE-SUGAR study findings is also briefly discussed in the conclusion of this review.

Keywords: intensive insulin therapy, intensive care, mortality, myocardial infarction