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Giving intensive insulin therapy to patients with elevated blood-glucose levels in the surgical intensive care unit (ICU) of a hospital significantly reduces their chance of death, even if the patients did not previously have diabetes, say researchers in Belgium. Greet Van den Berghe, MD, PhD, and colleagues reported their results in the November 8, 2001, issue of The New England Journal of Medicine.
In a prospective, randomized, controlled study, researchers tested intensive insulin therapy on 1,548 surgical ICU patients for a period of 12 months. The patients were assigned to receive either intensive insulin therapy (maintaining their blood-glucose levels between 80 and 110 mg/dl) or conventional treatment (receiving insulin only if blood-glucose levels were higher than 215 mg/dl and keeping levels between 180 and 200 mg/dl). Novo Nordisk's Novolin insulin was used.
Of the conventionally treated patients who remained in ICU for more than five days, 8 percent died, compared to a 4.6 percent death rate among those who received intensive insulin treatment. Hospitalwide, there were 34 percent fewer deaths in intensively treated patients. In addition, 46 percent fewer of those patients had bloodstream infections; there were 50 percent fewer transfusions; renal failure requiring dialysis decreased 41 percent; critical illness polyneuropathy decreased 44 percent; and patients were less likely to need respiratory support.
"Intensive insulin therapy to maintain blood glucose at or below 110 mg/dl reduces morbidity and mortality among critically ill patients in the surgical intensive care unit," the researchers conclude.
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