Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit. This was the first landmark "tight glucose control" paper but subsequent studies (i.e. see NICE-SUGAR below) have demonstrated different results.
In a multicentre, randomized controlled trial comparing intensive glucose control (81-108 mg/dL / 4.5-6.0 mmol/L) with conventional glucose control (≤180 mg/dL / ≤ 10.0 mmol/L) in 6,104 adult medical and surgical patients, intensive glucose control increased mortality (27.5% vs 24.9%; odds ratio 1.14; 95% CI 1.02 to 1.28; P=0.02). There was no significant difference between medical and surgical patients (odds ratio 1.31 and 1.07 respectively; P=0.10). Severe hypoglycaemic episodes (blood glucose level ≤40mg/dL / 2.2 mmol/L) were more common in the intensive glucose control group (6.8% vs 0.5%; P<0.001). There were no significant differences in the median number of days of mechanical ventilation (P=0.56) or renal-replacement therapy (P=0.39), or days in ICU (P=0.84) or hospital (P=0.86).
Compared with conventional insulin therapy, intensive insulin therapy did not improve in-hospital mortality among patients who were treated with hydrocortisone for septic shock. The addition of oral fludrocortisone did not result in a statistically significant improvement in in-hospital mortality.