6/28/23, 11:41 PM Intensive insulin therapy Pathway Feedback Search Clinical Topics Home Studies Intensive insulin therapy Intensive insulin therapy Disease In-hospital hyperglycemia Trial question What is the effect of intensive insulin therapy in critically ill patients who are receiving mechanical ventilation? Study design Single center Open label RCT Population Characteristics of study participants 29.0% female N = 1548 71.0% male 1548 patients (447 female, 1101 male) Inclusion criteria: adults admitted to surgical ICU who were receiving mechanical ventilation Key exclusion criteria: participation in other trials, moribund, or do-not-resuscitate orders Interventions N=765 intensive treatment (maintenance of blood glucose at a level between 80 and 110 mg/dL) N=783 conventional treatment (insulin infusion only if the blood glucose level > 215 mg/dL and maintenance of glucose at a level between 180 and 200 mg/dL) Primary outcome Death during intensive care 8.0 % 8 https://web.pathway.md/studies/recLaYzzznRvygFkr 1/2 6/28/23, 11:41 PM Intensive insulin therapy Pathway 6.0 % 4.6 4.0 % Significant increase 2.0 % NNH = 29 0.0 % Intensive treatment Conventional treatment Significant increase in death during intensive care (4.6% vs. 8%; RR 32, 95% CI 2 to 55) Secondary outcomes Significant decrease in death in the hospital (7.2% vs. 10.9%; RR 0.66, 95% CI 0.16 to 1.16) Significant decrease in the rate of prolonged ventilatory support for > 14 days (7.5% vs. 11.9%; RR 0.63, 95% CI 0.21 to 1.05) Safety outcomes No significant differences in red cell transfusion, inotropic or vasopressor treatment. Significant differences in dialysis or continuous venovenous hemofiltration (4.8% vs. 8.2%), septicemia during intensive care (4.2% vs. 7.8%), critical-illness polyneuropathy (28.7% vs. 51.9%). Conclusion In adults admitted to surgical ICU who were receiving mechanical ventilation, intensive treatment was superior to conventional treatment with respect to death during intensive care. Reference van den Berghe G, Wouters P, Weekers F et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001 Nov 8;345(19):1359-67. Open reference URL https://web.pathway.md/studies/recLaYzzznRvygFkr 2/2