***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE There is conflicting evidence regarding the benefit of intravenous insulin therapy on mortality following acute myocardial infa rct ion ( AMI ) . The goal of the current study was to determine whether improved glycemic control , achieved through an insulin/dextrose infusion with a variable rate of insulin , reduces mortality among hyperglycemic patients with AMI . RESEARCH DESIGN AND METHODS Subjects suffering AMI with either known diabetes or without diabetes but blood glucose level ( BGL ) > or = 7.8 mmol/l were r and omized to receive  insulin/dextrose infusion therapy  for at least 24 h to maintain a BGL < 10 mmol/l or conventional therapy . RESULTS A total of 240 subjects were recruited .  Insulin/dextrose infusion did not reduce mortality at the inpatient stage ( 4.8 vs. conventional 3.5 % , P = 0.75 ) , 3 months ( 7.1 vs 4.4 % , P = 0.42 ) , or 6 months ( 7.9 vs. 6.1 % , P = 0.62 ) . There was , however , a lower incidence of cardiac failure ( 12.7 vs. 22.8 % , P = 0.04 ) and reinfa rct ion within 3 months ( 2.4 vs. 6.1 % , P = 0.05 ) . When analyzed by mean BGL achieved during the first 24 h , mortality was lower among subjects with a mean BGL < or = 8 mmol/l , compared with subjects with a mean BGL > 8 mmol/l ( 2 vs. 11 % at 6 months , P = 0.02 ) . CONCLUSIONS We did not find a reduction in mortality among patients who received insulin/dextrose infusion therapy . However , it remains possible that tight glycemic control with insulin therapy following AMI improves outcomes PURPOSE Hospitalized patients with type 2 diabetes mellitus traditionally receive insulin on a sliding-scale regimen , but the benefits of this approach are unclear . The purpose of this study was to compare the effects of the sliding scale insulin regimen with those of routine diabetes medications on hyperglycemia , hypoglycemia and length of hospitalization in diabetic patients hospitalized for other conditions . METHODS This was a multicenter , r and omized controlled trial conducted in family medicine inpatient services . One hundred fifty-three patients with type 2 diabetes mellitus hospitalized for other conditions were r and omized to receive routine diabetes medications ( control ) or the combination of a st and ard sliding-scale insulin regimen and routine diabetes medications ( intervention ) . The outcome measures included frequency of hyperglycemia and hypoglycemia ( glycemic events ) , and length of hospitalization . RESULTS No differences were identified between treatment groups in the frequency of glycemic events . In the intervention group , 33.3 % of patients developed hyperglycemia compared to 34.6 % in the control group ( P = .87 ) . Six patients developed hypoglycemia in the intervention group , compared with 7 in the control group ( P = .83 ) . There was no difference in length of hospitalization ( P = .86 ) . Regardless of treatment assignment , patients receiving intermediate-acting insulin ( OR , 2.8 ; 95 % CI , 1.2–6.5 ) , those with blood glucose values greater than 250 mg/dL at baseline ( OR , 6.3 ; 95 % CI , 2.3 – 17.2 ) and those receiving corticosteroids ( OR , 9.1 ; 95 % CI , 3.1 – 27.0 ) were more likely to have glycemic events . CONCLUSIONS The use of the sliding scale insulin regimen in combination with routine diabetes medications does not affect the rate of hyperglycemia , hypoglycemia or length of hospitalization in patients with type 2 diabetes mellitus hospitalized for other conditions OBJECTIVE Recent studies suggest that strict perioperative glycemic control improves clinical outcomes after cardiothoracic surgery . However , optimal methods and targets for controlling blood glucose ( BG ) levels in this setting have not been established . Currently published intensive insulin infusion protocol s ( IIPs ) have important practical limitations , which may affect their utility . In this article , the authors present their experience with a safe , effective , nurse-driven IIP , which was implemented simultaneously in 2 cardiothoracic intensive care units ( CTICUs ) . DESIGN Prospect i ve cohort study . SETTING Tertiary referral hospital and community teaching hospital . PARTICIPANTS CTICU patients . INTERVENTIONS A st and ardized , intensive IIP was used for all patients admitted to both CTICUs .  Hourly BG levels , relevant baseline variables , and clinical interventions were collected prospect ively from the active hospital chart and CTICU nursing records . MEASUREMENTS AND MAIN RESULTS The IIP was used 137 times in 118 patients . The median time required to reach target BG levels ( 100 - 139 mg/dL ) was 5 hours . Once BG levels decreased below 140 mg/dL , 58 % of 2,242 subsequent hourly BG values fell within the narrow target range , 73 % within a " clinical ly desirable " range of 80 to 139 mg/dL , and 94 % within a " clinical ly acceptable " range of 80 to 199 mg/dL. Only 5 ( 0.2 % ) BG values were less than 60 mg/dL , with no associated adverse clinical events . CONCLUSIONS The IIP safely and effectively improved glycemic control in 2 CTICUs , with minimal hypoglycemia . Based on prior studies showing the benefits of strict glycemic control , the implementation of this IIP should help to reduce morbidity and mortality in CTICU patients OBJECTIVES We tested how insulin-glucose infusion followed by multidose insulin treatment in diabetic patients with acute myocardial infa rct ion affected mortality during the subsequent 12 months of follow-up . BACKGROUND Despite significant improvements in acute coronary care , diabetic patients with acute myocardial infa rct ion still have a high mortality rate . METHODS A total of 620 patients were studied : 306 r and omized to treatment with insulin-glucose infusion followed by multidose subcutaneous insulin for > or = 3 months and 314 to conventional therapy .  RESULTS The two groups were well matched for baseline characteristics . Blood glucose decreased from 15.4 + /- 4.1 to 9.6 + /- 3.3 mmol/liter ( mean + /- SD ) in the infusion group during the 1st 24 h , and from 15.7 + /- 4.2 to 11.7 + /- 4.1 among control patients ( p < 0.0001 ) . After 1 year 57 subjects ( 18.6 % ) in the infusion group and 82 ( 26.1 % ) in the control group had died ( relative mortality reduction 29 % , p = 0.027 ) . The mortality reduction was particularly evident in patients who had a low cardiovascular risk profile and no previous insulin treatment ( 3-month mortality rate 6.5 % in the infusion group vs. 13.5 % in the control group [ relative reduction 52 % , p = 0.046 ] ; 1-year mortality rate 8.6 % in the infusion group vs. 18.0 % in the control group [ relative reduction 52 % , p = 0.020 ] ) . CONCLUSIONS Insulin-glucose infusion followed by a multidose insulin regimen improved long-term prognosis in diabetic patients with acute myocardial infa rct ion CONTEXT While glucose control is recommended by professional societies for patients with hyperglycemia hospitalized with acute myocardial infa rct ion ( AMI ) , enthusiasm for glucose lowering is tempered , in part , by concerns of inducing hypoglycemia . Yet , whether episodic hypoglycemia that occurs as a result of glucose-lowering therapy is harmful in patients with AMI is unknown . OBJECTIVE To determine whether the mortality risk associated with hypoglycemic events is similar in patients who develop hypoglycemia spontaneously and those who develop it as a result of insulin therapy .  DESIGN , SETTING , AND PATIENTS Retrospective cohort study using data from Health Facts , a contemporary data base of patients hospitalized across the United States in 40 hospitals between January 1 , 2000 , and December 31 , 2005 . Of all the patients in the data base , 7820 patients were hospitalized with AMI and were hyperglycemic on admission ( glucose level > or = 140 mg/dL ) . Patients were stratified based on whether they developed a hypoglycemic event ( r and om glucose level < 60 mg/dL ) during subsequent hospitalization . Logistic regression models were used to evaluate the association between hypoglycemia and in-hospital mortality within subgroups of patients who were and were not treated with insulin therapy . MAIN OUTCOME MEASURE All-cause in-hospital mortality . RESULTS Among patients treated or not treated with insulin , those with hypoglycemia were older and had more comorbidity . Hypoglycemia was associated with increased mortality in patients not treated with insulin ( 18.4 % [ 25/136 ] mortality in patients with hypoglycemia vs 9.2 % [ 425/4639 ] in those without hypoglycemia ; P<.001 ) , but not in those treated with insulin ( 10.4 % [ 36/346 ] mortality in patients with hypoglycemia vs 10.2 % [ 276/2699 ] in those without hypoglycemia ; P = .92 ) . After multivariable adjustment , there was a significant interaction between hypoglycemia and insulin therapy ( P value for interaction = .01 ) . Hypoglycemia was a predictor of higher mortality in patients who were not treated with insulin ( odds ratio , 2.32 [ 95 % confidence interval , 1.31 - 4.12 ] vs patients without hypoglycemia ) , but not in patients treated with insulin ( odds ratio , 0.92 [ 95 % confidence interval , 0.58 - 1.45 ] vs patients without hypoglycemia ) . CONCLUSIONS While hypoglycemia was associated with increased mortality in patients with AMI , this risk was confined to patients who developed hypoglycemia spontaneously . In contrast , iatrogenic hypoglycemia after insulin therapy was not associated with higher mortality risk CONTEXT Hyperglycemia is common in critically ill patients , even in those without diabetes mellitus . Aggressive glycemic control may reduce mortality in this population . However , the relationship between mortality , the control of hyperglycemia , and the administration of exogenous insulin is unclear . OBJECTIVE To determine whether blood glucose level or quantity of insulin administered is associated with reduced mortality in critically ill patients . DESIGN , SETTING , AND PATIENTS Single-center , prospect i ve , observational study of 531 patients ( median age , 64 years ) newly admitted over the first 6 months of 2002 to an adult intensive care unit ( ICU ) in a UK national referral center for cardiorespiratory surgery and medicine . MAIN OUTCOME MEASURES The primary end point was intensive care unit ( ICU ) mortality . Secondary end points were hospital mortality , ICU and hospital length of stay , and predicted threshold glucose level associated with risk of death . RESULTS Of 531 patients admitted to the ICU , 523 underwent analysis of their glycemic control . Twenty-four-hour control of blood glucose levels was variable . Rates of ICU and hospital mortality were 5.2 % and 5.7 % , respectively ; median lengths of stay were 1.8 ( interquartile range , 0.9 - 3.7 ) days and 6 ( interquartile range , 4.5 - 8.3 ) days , respectively . Multivariable logistic regression demonstrated that increased administration of insulin was positively and significantly associated with ICU mortality ( odds ratio , 1.02 [ 95 % confidence interval , 1.01 - 1.04 ] at a prevailing glucose level of 111 - 144 mg/dL [ 6.1 - 8.0 mmol/L ] for a 1-IU/d increase ) , suggesting that mortality benefits are attributable to glycemic control rather than increased administration of insulin . Also , the regression models suggest that a mortality benefit accrues below a predicted threshold glucose level of 144 to 200 mg/dL ( 8.0 - 11.1 mmol/L ) , with a speculative upper limit of 145 mg/dL ( 8.0 mmol/L ) for the target blood glucose level . CONCLUSIONS Increased insulin administration is positively associated with death in the ICU regardless of the prevailing blood glucose level . Thus , control of glucose levels rather than of absolute levels of exogenous insulin appear to account for the mortality benefit associated with intensive insulin therapy demonstrated by others Good blood glucose control in hospitalized adults leads to reduced mortality . Intravenous ( IV ) insulin has been shown to be an effective way to achieve tight control of blood glucose . Managing IV insulin is a labor-intensive task for nurses 
    Output:
    
No consistent evidence showed that IIT reduced long-term mortality , infection rates , length of stay , or the need for renal replacement therapy .
Risk for IIT-associated hypoglycemia was increased in all hospital setting s. LIMITATIONS Method ological shortcomings and inconsistencies limit the data in perioperative care , myocardial infa rct ion , and stroke or brain injury setting s. Differences in insulin protocol s and patient and hospital characteristics may affect generalizability across treatment setting s. CONCLUSION No consistent evidence demonstrates that IIT targeted to strict glycemic control compared with less strict glycemic control improves health outcomes in hospitalized patients .
Furthermore , IIT is associated with an increased risk for severe hypoglycemia .