Insulin-based regimens decrease mortality rates in critically ill patients: a systematic review.

OBJECTIVES

To determine whether treatment with glucose-insulin-potassium (GIK), insulin and glucose, or insulin by itself is beneficial in limiting organ damage after acute myocardial infarction (AMI) and reducing mortality and morbidity among critically ill hyperglycaemic patients.

METHODS

Systematic review of randomized controlled trials.

MAIN OUTCOME MEASURE

To assess whether tight glycaemic control reduces morbidity and mortality.

STUDIES REVIEWED

Randomized controlled trials of insulin-based regimens in the treatment of critically ill patients.

RESULTS

Nine hundred and twenty-four potentially relevant studies were identified and screened for retrieval. Of these, 16 randomized controlled trials met the inclusion criteria (Table 1). Ten studies examined the effects of GIK, and six of these studies reported a mortality reduction with GIK treatment in addition to enhanced myocardial performance. Five studies examined the administration of insulin. Among these studies, tight glycaemic control of blood glucose in one study was shown to reduce morbidity and mortality of patients in intensive care. Only one study examined insulin/glucose therapy, and it showed a post-myocardial infarction mortality reduction of one year.

CONCLUSIONS

There is increasing evidence that maintaining normoglycaemia and treatment with insulin-based regimens is beneficial in limiting organ damage and significantly reduces both morbidity and mortality in critically ill patients who require intensive care therapy.