Intensive insulin therapy and mortality in critically ill patients

Miriam Treggiari, Veena Karir, N. David Yanes, Noel S. Weiss, Stephen Daniel, Steven A. Deem

Research output: Contribution to journalArticle

126 Citations (Scopus)

Abstract

Introduction: Intensive insulin therapy (IIT) with tight glycemic control may reduce mortality and morbidity in critically ill patients and has been widely adopted in practice throughout the world. However, there is only one randomized controlled trial showing unequivocal benefit to this approach and that study population was dominated by post-cardiac surgery patients. We aimed to determine the association between IIT and mortality in a mixed population of critically ill patients. Methods: We conducted a cohort study comparing three consecutive time periods before and after IIT protocol implementation in a Level 1 trauma center: period I (no protocol); period II, target glucose 80 to 130 mg/ dL; and period III, target glucose 80 to 110 mg/dL. Subjects were 10,456 patients admitted to intensive care units (ICUs) between 1 March 2001 and 28 February 2005. The main study endpoints were ICU and hospital mortality, Sequential Organ Failure Assessment score, and occurrence of hypoglycemia. Multivariable regression analysis was used to evaluate mortality and organ dysfunction during periods II and III relative to period I. Results: Insulin administration increased over time (9% period I, 25% period II, and 42% period III). Nonetheless, patients in period III had a tendency toward higher adjusted hospital mortality (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.98, 1.35) than patients in period I. Excess hospital mortality in period III was present primarily in patients with an ICU length of stay of 3 days or less (OR 1.47, 95% CI 1.11, 1.93 There was an approximately fourfold increase in the incidence of hypoglycemia from periods I to III. Conclusion: A policy of IIT in agroup of ICUs from a single institution was not associated with a decrease in hospital mortality. These results, combined with the findings from several recent randomized trials, suggest that further study is needed prior to widespread implementation of IIT in critically ill patients.

Original languageEnglish (US)
Article numberR29
JournalCritical Care
Volume12
Issue number1
DOIs
StatePublished - Feb 29 2008
Externally publishedYes

Fingerprint

Critical Illness
Insulin
Mortality
Hospital Mortality
Intensive Care Units
Therapeutics
Hypoglycemia
Odds Ratio
Confidence Intervals
Organ Dysfunction Scores
Glucose
Trauma Centers
Population
Thoracic Surgery
Length of Stay
Cohort Studies
Randomized Controlled Trials
Regression Analysis
Morbidity
Incidence

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Treggiari, M., Karir, V., Yanes, N. D., Weiss, N. S., Daniel, S., & Deem, S. A. (2008). Intensive insulin therapy and mortality in critically ill patients. Critical Care, 12(1), [R29]. https://doi.org/10.1186/cc6807

Intensive insulin therapy and mortality in critically ill patients. / Treggiari, Miriam; Karir, Veena; Yanes, N. David; Weiss, Noel S.; Daniel, Stephen; Deem, Steven A.

In: Critical Care, Vol. 12, No. 1, R29, 29.02.2008.

Research output: Contribution to journalArticle

Treggiari, M, Karir, V, Yanes, ND, Weiss, NS, Daniel, S & Deem, SA 2008, 'Intensive insulin therapy and mortality in critically ill patients', Critical Care, vol. 12, no. 1, R29. https://doi.org/10.1186/cc6807
Treggiari, Miriam ; Karir, Veena ; Yanes, N. David ; Weiss, Noel S. ; Daniel, Stephen ; Deem, Steven A. / Intensive insulin therapy and mortality in critically ill patients. In: Critical Care. 2008 ; Vol. 12, No. 1.
@article{b44d5956f84a4a4b90132a5449925590,
title = "Intensive insulin therapy and mortality in critically ill patients",
abstract = "Introduction: Intensive insulin therapy (IIT) with tight glycemic control may reduce mortality and morbidity in critically ill patients and has been widely adopted in practice throughout the world. However, there is only one randomized controlled trial showing unequivocal benefit to this approach and that study population was dominated by post-cardiac surgery patients. We aimed to determine the association between IIT and mortality in a mixed population of critically ill patients. Methods: We conducted a cohort study comparing three consecutive time periods before and after IIT protocol implementation in a Level 1 trauma center: period I (no protocol); period II, target glucose 80 to 130 mg/ dL; and period III, target glucose 80 to 110 mg/dL. Subjects were 10,456 patients admitted to intensive care units (ICUs) between 1 March 2001 and 28 February 2005. The main study endpoints were ICU and hospital mortality, Sequential Organ Failure Assessment score, and occurrence of hypoglycemia. Multivariable regression analysis was used to evaluate mortality and organ dysfunction during periods II and III relative to period I. Results: Insulin administration increased over time (9{\%} period I, 25{\%} period II, and 42{\%} period III). Nonetheless, patients in period III had a tendency toward higher adjusted hospital mortality (odds ratio [OR] 1.15, 95{\%} confidence interval [CI] 0.98, 1.35) than patients in period I. Excess hospital mortality in period III was present primarily in patients with an ICU length of stay of 3 days or less (OR 1.47, 95{\%} CI 1.11, 1.93 There was an approximately fourfold increase in the incidence of hypoglycemia from periods I to III. Conclusion: A policy of IIT in agroup of ICUs from a single institution was not associated with a decrease in hospital mortality. These results, combined with the findings from several recent randomized trials, suggest that further study is needed prior to widespread implementation of IIT in critically ill patients.",
author = "Miriam Treggiari and Veena Karir and Yanes, {N. David} and Weiss, {Noel S.} and Stephen Daniel and Deem, {Steven A.}",
year = "2008",
month = "2",
day = "29",
doi = "10.1186/cc6807",
language = "English (US)",
volume = "12",
journal = "Critical Care",
issn = "1364-8535",
publisher = "BioMed Central Ltd.",
number = "1",

}

TY - JOUR

T1 - Intensive insulin therapy and mortality in critically ill patients

AU - Treggiari, Miriam

AU - Karir, Veena

AU - Yanes, N. David

AU - Weiss, Noel S.

AU - Daniel, Stephen

AU - Deem, Steven A.

PY - 2008/2/29

Y1 - 2008/2/29

N2 - Introduction: Intensive insulin therapy (IIT) with tight glycemic control may reduce mortality and morbidity in critically ill patients and has been widely adopted in practice throughout the world. However, there is only one randomized controlled trial showing unequivocal benefit to this approach and that study population was dominated by post-cardiac surgery patients. We aimed to determine the association between IIT and mortality in a mixed population of critically ill patients. Methods: We conducted a cohort study comparing three consecutive time periods before and after IIT protocol implementation in a Level 1 trauma center: period I (no protocol); period II, target glucose 80 to 130 mg/ dL; and period III, target glucose 80 to 110 mg/dL. Subjects were 10,456 patients admitted to intensive care units (ICUs) between 1 March 2001 and 28 February 2005. The main study endpoints were ICU and hospital mortality, Sequential Organ Failure Assessment score, and occurrence of hypoglycemia. Multivariable regression analysis was used to evaluate mortality and organ dysfunction during periods II and III relative to period I. Results: Insulin administration increased over time (9% period I, 25% period II, and 42% period III). Nonetheless, patients in period III had a tendency toward higher adjusted hospital mortality (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.98, 1.35) than patients in period I. Excess hospital mortality in period III was present primarily in patients with an ICU length of stay of 3 days or less (OR 1.47, 95% CI 1.11, 1.93 There was an approximately fourfold increase in the incidence of hypoglycemia from periods I to III. Conclusion: A policy of IIT in agroup of ICUs from a single institution was not associated with a decrease in hospital mortality. These results, combined with the findings from several recent randomized trials, suggest that further study is needed prior to widespread implementation of IIT in critically ill patients.

AB - Introduction: Intensive insulin therapy (IIT) with tight glycemic control may reduce mortality and morbidity in critically ill patients and has been widely adopted in practice throughout the world. However, there is only one randomized controlled trial showing unequivocal benefit to this approach and that study population was dominated by post-cardiac surgery patients. We aimed to determine the association between IIT and mortality in a mixed population of critically ill patients. Methods: We conducted a cohort study comparing three consecutive time periods before and after IIT protocol implementation in a Level 1 trauma center: period I (no protocol); period II, target glucose 80 to 130 mg/ dL; and period III, target glucose 80 to 110 mg/dL. Subjects were 10,456 patients admitted to intensive care units (ICUs) between 1 March 2001 and 28 February 2005. The main study endpoints were ICU and hospital mortality, Sequential Organ Failure Assessment score, and occurrence of hypoglycemia. Multivariable regression analysis was used to evaluate mortality and organ dysfunction during periods II and III relative to period I. Results: Insulin administration increased over time (9% period I, 25% period II, and 42% period III). Nonetheless, patients in period III had a tendency toward higher adjusted hospital mortality (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.98, 1.35) than patients in period I. Excess hospital mortality in period III was present primarily in patients with an ICU length of stay of 3 days or less (OR 1.47, 95% CI 1.11, 1.93 There was an approximately fourfold increase in the incidence of hypoglycemia from periods I to III. Conclusion: A policy of IIT in agroup of ICUs from a single institution was not associated with a decrease in hospital mortality. These results, combined with the findings from several recent randomized trials, suggest that further study is needed prior to widespread implementation of IIT in critically ill patients.

UR - http://www.scopus.com/inward/record.url?scp=40749112815&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=40749112815&partnerID=8YFLogxK

U2 - 10.1186/cc6807

DO - 10.1186/cc6807

M3 - Article

C2 - 18312617

AN - SCOPUS:40749112815

VL - 12

JO - Critical Care

JF - Critical Care

SN - 1364-8535

IS - 1

M1 - R29

ER -