***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: People with diabetes are more likely to be hospitalized and to have longer duration s of hospital stay than those without diabetes . A recent survey estimated that 22 % of all hospital inpatient days were incurred by people with diabetes and that hospital inpatient care accounted for half of the 174 billion USD total U.S. medical expenditures for this disease ( 1 ) . These findings are due , in part , to the continued expansion of the worldwide epidemic of type 2 diabetes . In the U.S. alone , there are ∼1.6 million new cases of diabetes each year , with an over all prevalence of 23.6 million people ( 7.8 % of the population , with one-fourth of the cases remaining undiagnosed ) . An additional 57 million American adults are at high risk for type 2 diabetes ( 2 ) . Although the costs of illness-related stress hyperglycemia are not known , they are likely to be considerable in light of the poor prognosis of such patients ( 3–6 ) . There is substantial observational evidence linking hyperglycemia in hospitalized patients ( with or without diabetes ) to poor outcomes . Cohort studies as well as a few early r and omized controlled trials ( RCTs ) have suggested that intensive treatment of hyperglycemia improved hospital outcomes ( 5–8 ) . In 2004 , this evidence led the American College of Endocrinology ( ACE ) and the American Association of Clinical Endocrinologists ( AACE ) , in collaboration with the American Diabetes Association ( ADA ) and other medical organizations , to develop recommendations for treatment of inpatient hyperglycemia  ( 9 ) . In 2005 , the ADA added recommendations for treatment  of hyperglycemia in the hospitalto itsannual St and ards of Medical Care ( 10 ) . Recommendations from the ACE and the ADA generally endorsed tight glycemic control in critical care units . For patients in general medical and surgical units , where RCT evidence regarding treatment targets was lacking , glycemic goals similar to those advised for out patients were advocated ( 9 , Objectives : To examine the predisposing factors for hypoglycemia in medical-surgical intensive care unit patients treated with intensive insulin therapy  and to assess its association with mortality . Design : Nested-cohort study within a r and omized controlled trial . Setting : Tertiary care intensive care unit . Participants : Medical-surgical intensive care unit patients with admission blood glucose of > 6.1 mmol/L or 110 mg/dL who were enrolled in a r and omized controlled trial comparing intensive insulin therapy with conventional insulin therapy .  Interventions : None . Exposure : Hypoglycemia was defined as blood glucose ≤2.2 mmol/L or 40 mg/dL and intensive care unit mortality was the primary outcome . Measurements and Main Results : Among the 523 patients included in the study , hypoglycemia occurred in 84 ( 16 % ) . Intensive insulin therapy was independently associated with increased risk of hypoglycemia ( adjusted odds ratio , 50.65 ; 95 % confidence interval , 17.36–147.78 ; p < .0001 ) . Other variables associated with an increased risk of hypoglycemia included female gender , diabetes , Acute Physiology and Chronic Health Evaluation II , mechanical ventilation , continuous veno-venous hemodialysis , and intensive care unit length of stay . When adjusted to potential confounders , hypoglycemia was not significantly associated with increased mortality ( adjusted hazard ratio , 1.31 ; 95 % confidence interval , .70–2.46 ; p = .40 ) . Patients with admission blood glucose of ≤10 mmol/L had an increased mortality with hypoglycemia ( adjusted hazard ratio , 4.43 ; 95 % confidence interval , 1.36–14.44 ; p = .01 ) . Crude analysis showed significant association of mortality with blood glucose levels of ≤1.2 mmol/L ( adjusted hazard ratio , 2.92 ; 95 % confidence interval , 1.05–8.11 ; p = .04 ) . When adjusted analysis was performed , similar trend was seen but was not statistically significant ( adjusted hazard ratio , 2.56 ; 95 % confidence interval , .85–7.70 ; p = .10 ) . Conclusions : Our study showed significant increase of hypoglycemia  with intensive insulin therapy . Although hypoglycemia was not independently associated with increased risk of death , increased mortality could not be excluded with severe hypoglycemia and in patients admitted with blood glucose of ≤10 Admission hyperglycemia has been associated with increased hospital mortality in critically ill patients ; however , it is not known whether hyperglycemia in patients admitted to general hospital wards is associated with poor outcome . The aim of this study was to determine the prevalence of in-hospital hyperglycemia and determine the survival and functional outcome of patients with hyperglycemia with and without a history of diabetes . We review ed the medical records of 2030 consecutive adult patients admitted to Georgia Baptist Medical Center , a community teaching hospital in downtown Atlanta , GA , from July 1 , 1998 , to October 20 , 1998 . New hyperglycemia was defined as an admission or in-hospital fasting glucose level of 126 mg/dl ( 7 mmol/liter ) or more or a r and om blood glucose level of 200 mg/dl ( 11.1 mmol/liter ) or more on 2 or more determinations . Hyperglycemia was present in 38 % of patients admitted to the hospital , of whom 26 % had a known history of diabetes , and 12 % had no history of diabetes before the admission . Newly discovered hyperglycemia was associated with higher in-hospital mortality rate ( 16 % ) compared with those patients with a prior history of diabetes ( 3 % ) and subjects with normoglycemia ( 1.7 % ; both P < 0.01 ) . In addition , new hyperglycemic patients had a longer length of hospital stay , a higher admission rate to an intensive care unit , and were less likely to be discharged to home , frequently requiring transfer to a transitional care unit or nursing home facility . Our results indicate that in-hospital hyperglycemia is a common finding and represents an important marker of poor clinical outcome and mortality in patients with and without a history of diabetes . Patients with newly diagnosed hyperglycemia had a significantly higher mortality rate and a lower functional outcome than patients with a known history of diabetes or normoglycemia Introduction Intensive insulin therapy ( IIT ) with tight glycemic control may reduce mortality and morbidity in critically ill patients and has been widely adopted in practice throughout the world . However , there is only one r and omized controlled trial showing unequivocal benefit to this approach and that study population was dominated by post-cardiac surgery patients . We aim ed to determine the association between IIT and mortality in a mixed population of critically ill patients . Methods We conducted a cohort study comparing three consecutive time periods before and after IIT protocol implementation in a Level 1 trauma center : period I ( no protocol ) ; period II , target glucose 80 to 130 mg/dL ; and period III , target glucose 80 to 110 mg/dL. Subjects were 10,456 patients admitted to intensive care units ( ICUs ) between 1 March 2001 and 28 February 2005 . The main study endpoints were ICU and hospital mortality , Sequential Organ Failure Assessment score , and occurrence of hypoglycemia . Multivariable regression analysis was used to evaluate mortality and organ dysfunction during periods II and III relative to period I. Results Insulin administration increased over time ( 9 % period I , 25 % period II , and 42 % period III ) . Nonetheless , patients in period III had a tendency toward higher adjusted hospital mortality ( odds ratio [ OR ] 1.15 , 95 % confidence interval [ CI ] 0.98 , 1.35 ) than patients in period I. Excess hospital mortality in period III was present primarily in patients with an ICU length of stay of 3 days or less ( OR 1.47 , 95 % CI 1.11 , 1.93 There was an approximately fourfold increase in the incidence of hypoglycemia from periods I to III . Conclusion A policy of IIT in a group of ICUs from a single institution was not associated with a decrease in hospital mortality . These results , combined with the findings from several recent r and omized trials , suggest that further study is needed prior to widespread implementation of IIT in critically ill patients BACKGROUND The role of intensive insulin therapy in patients with severe sepsis is uncertain . Fluid resuscitation improves survival among patients with septic shock , but evidence is lacking to support the choice of either crystalloids or colloids . METHODS In a multicenter , two-by-two factorial trial , we r and omly assigned patients with severe sepsis to receive either intensive insulin therapy to maintain euglycemia or conventional insulin therapy and either 10 % pentastarch , a low-molecular-weight hydroxyethyl starch ( HES 200/0.5 ) , or modified Ringer 's lactate for fluid resuscitation . The rate of death at 28 days and the mean score for organ failure were co primary end points . RESULTS The trial was stopped early for safety reasons . Among 537 patients who could be evaluated , the mean morning blood glucose level was lower in the intensive-therapy group ( 112 mg per deciliter [ 6.2 mmol per liter ] ) than in the conventional-therapy group ( 151 mg per deciliter [ 8.4 mmol per liter ] , P<0.001 ) . However , at 28 days , there was no significant difference between the two groups in the rate of death or the mean score for organ failure . The rate of severe hypoglycemia ( glucose level , < or = 40 mg per deciliter [ 2.2 mmol per liter ] ) was higher in the intensive-therapy group than in the conventional-therapy group ( 17.0 % vs. 4.1 % , P<0.001 ) , as was the rate of serious adverse events ( 10.9 % vs. 5.2 % , P=0.01 ) . HES therapy was associated with higher rates of acute renal failure and renal-replacement therapy than was Ringer 's lactate . CONCLUSIONS The use of intensive insulin therapy placed critically ill patients with sepsis at increased risk for serious adverse events related to hypoglycemia . As used in this study , HES was harmful , and its toxicity increased with accumulating doses . ( Clinical Trials.gov number , NCT00135473 . OBJECTIVE To determine the safety and efficacy of an intensive insulin regimen compared with a conventional insulin regimen in general intensive care unit patients . METHODS A phase II , r and omised controlled trial was conducted in 70 critically ill patients in a closed multidisciplinary ICU of a university-affiliated tertiary hospital . We assessed patient characteristics at baseline . Trial process measures included number of blood glucose measurements per day and number in target range , type and quantity of caloric intake , patient outcome and insulin dosing . The primary outcome was the median blood glucose concentration . Secondary outcome measures were incidence of hypoglycaemia ( blood glucose level < 2.2 mmol/L ) , clinical sequelae of hypoglycaemia and hospital mortality . RESULTS Thirty-five patients were r and omised to each of the two groups . More blood glucose sample s were taken per day in the intensive insulin group ( 16 versus 9 ) , but the number of sample s in the normoglycaemic range was 48.5 % , compared with 79.8 % within the target glucose range in the conventional insulin group . The median ( interquartile range ) blood glucose concentrations in the intensive and conventional insulin therapy groups were 5.4 ( 5.1 - 5.7 ) mmol/L and 7.9 ( 7.2 - 9.0 ) mmol/L , respectively ( difference , 2.5 mmol/L ; P < 0.0001 ) . Five patients ( 14.3 % ) in the intensive insulin therapy group became hypoglycaemic versus none in the conventional insulin therapy group . There were no detected clinical sequelae of hypoglycaemia . CONCLUSION The intensive insulin regimen was effective in achieving the target blood glucose concentration , with clear separation from the conventional insulin regimen . Although the incidence of hypoglycaemia was increased , there was no detectable harm Objective Elevated blood glucose is associated with poor outcome in patients resuscitated from out-of-hospital cardiac arrest ( OHCA ) . Our aim was to determine whether strict glucose control with intensive insulin treatment improves outcome of OHCA patients . Design A r and omized , controlled trial . Setting Two university hospital intensive care units . Patients Ninety patients resuscitated from OHCA with ventricular fibrillation detected as the initial rhythm were treated with therapeutic hypothermia .  Interventions Patients were r and omized into two treatment groups : a strict glucose control group ( SGC group ) , with a blood glucose target of 4–6 mmol/l , or a moderate glucose control group ( MGC group ) , with a blood glucose target of 6–8 mmol/l . Both groups were treated with insulin infusion for 48 h , because a control group with no treatment was considered unethical . Measurements and results Baseline data were similar in both groups . In the SGC group 71 % of the glucose measurements were within the target range compared with 41 % in the MGC group . Median glucose 
    Output:
    
Until further studies prove otherwise , nonsurgical patients requiring glycemic management are best served with less intensive regimens than their surgical counterparts .
Based on the results of this review and data from the four included studies , glycemic management for medical patients in the intensive care unit should differ from that of surgical patients .