How does blood glucose control with insulin save lives in intensive care?
Greet Van den Berghe
Greet Van den Berghe
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Science in Medicine

How does blood glucose control with insulin save lives in intensive care?

Abstract

Patients requiring prolonged intensive care are at high risk for multiple organ failure and death. Insulin resistance and hyperglycemia accompany critical illness, and the severity of this “diabetes of stress” reflects the risk of death. Recently it was shown that preventing hyperglycemia with insulin substantially improves outcome of critical illness. This article examines some potential mechanisms underlying prevention of glucose toxicity as well as the effects of insulin independent of glucose control. Unraveling the molecular mechanisms will provide new insights into the pathogenesis of multiple organ failure and open avenues for novel therapeutic strategies.

Authors

Greet Van den Berghe

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Intensive insulin therapy saves lives in the intensive care unit. Kaplan...
Intensive insulin therapy saves lives in the intensive care unit. Kaplan-Meier curves show cumulative survival of 1,548 patients from the Leuven study who received intensive insulin treatment (blood glucose maintained below 110 mg/dl; yellow) or conventional insulin treatment (insulin only given when blood glucose exceeded 200 mg/dl, resulting in mean blood glucose levels of 150–160 mg/dl; green) during their ICU or hospital stay. The upper panels display results from all patients; the lower panels display results for long-stay (>5 days) ICU patients only. P values were determined with the use of the Mantel-Cox log-rank test. Adapted with permission from the New England Journal of Medicine (10).