Clinical study of the month. Toxicity of hyperglycemia in intensive care and beneficial effects of optimized insulin therapy

A large Belgian, prospective, controlled study was performed in 1.548 critically ill patients (83% without history of diabetes) hospitalised in a surgical intensive care unit. On admission, patients were randomly assigned to receive intensive intravenous insulin therapy (maintenance of blood glucose at a level between 80 and 110 mg/dl) or conventional treatment (infusion of insulin only if the blood glucose level exceeded 215 mg/dl and maintenance of glucose at a level between 180 and 200 mg/dl). Intensive insulin therapy reduced morbidity and mortality by 40%. These remarkable results should influence further therapeutical attitudes in intensive care units and open new perspectives for the management of critically ill patients.