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Erschienen in: Diabetologia 6/2008

01.06.2008 | For Debate

Insulin therapy in the intensive care unit should be targeted to maintain blood glucose between 4.4 mmol/l and 6.1 mmol/l

verfasst von: G. Van den Berghe

Erschienen in: Diabetologia | Ausgabe 6/2008

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Excerpt

Hyperglycaemia has been repeatedly associated with risk of mortality and morbidity in the intensive care unit (ICU). However, establishing a causal relationship between hyperglycaemia and adverse outcome requires randomised controlled trials assessing the impact of treating/preventing hyperglycaemia in this condition. The only two randomised controlled studies that have addressed this question so far targeted normoglycaemia (4.4–6.1 mmol/l) in ICUs and showed that the link indeed appears causal. The evidence currently available is thus in favour of a ‘normal ≤6.1 mmol/l’ level for blood glucose control in ICUs and is not supportive of J. Miles’s viewpoint in this debate [1], as studies on any other level have not been performed. …
Literatur
2.
Zurück zum Zitat Van den Berghe G, Wouters P, Weekers F et al (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345:1359–1367PubMedCrossRef Van den Berghe G, Wouters P, Weekers F et al (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345:1359–1367PubMedCrossRef
3.
Zurück zum Zitat Van den Berghe G, Schoonheydt K, Becx P et al (2005) Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology 64:1348–1353PubMed Van den Berghe G, Schoonheydt K, Becx P et al (2005) Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology 64:1348–1353PubMed
4.
Zurück zum Zitat Van den Berghe G, Wouters PJ, Kesteloot K et al (2006) Analysis of healthcare resource utilization with intensive insulin therapy in critically ill patients. Crit Care Med 34:612–616PubMed Van den Berghe G, Wouters PJ, Kesteloot K et al (2006) Analysis of healthcare resource utilization with intensive insulin therapy in critically ill patients. Crit Care Med 34:612–616PubMed
5.
Zurück zum Zitat Ingels C, Debaveye Y, Milants I et al (2006) Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care and quality of life. Eur Heart J 27:2716–2724PubMedCrossRef Ingels C, Debaveye Y, Milants I et al (2006) Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care and quality of life. Eur Heart J 27:2716–2724PubMedCrossRef
6.
Zurück zum Zitat Krinsley JS (2004) Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 79:992–1000PubMedCrossRef Krinsley JS (2004) Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 79:992–1000PubMedCrossRef
7.
Zurück zum Zitat Krinsley JS, Jones RL (2006) Cost analysis of intensive glycemic control in critically ill adult patients. Chest 129:644–650PubMedCrossRef Krinsley JS, Jones RL (2006) Cost analysis of intensive glycemic control in critically ill adult patients. Chest 129:644–650PubMedCrossRef
8.
Zurück zum Zitat Brunkhorst FM, Kuhnt E, Engel C et al (2005) Intensive insulin therapy in patient with severe sepsis and septic shock is associated with an increased rate of hypoglycemia—results from a randomized multicenter study (VISEP). Infection 33 (Suppl 1):19 (abstract) Brunkhorst FM, Kuhnt E, Engel C et al (2005) Intensive insulin therapy in patient with severe sepsis and septic shock is associated with an increased rate of hypoglycemia—results from a randomized multicenter study (VISEP). Infection 33 (Suppl 1):19 (abstract)
11.
Zurück zum Zitat Van den Berghe G, Wilmer A, Hermans G et al (2006) Intensive insulin therapy in medical intensive care patients. N Engl J Med 354:449–461PubMedCrossRef Van den Berghe G, Wilmer A, Hermans G et al (2006) Intensive insulin therapy in medical intensive care patients. N Engl J Med 354:449–461PubMedCrossRef
12.
Zurück zum Zitat Hermans G, Wilmer A, Meersseman W et al (2007) Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit. Am J Respir Crit Care Med 175:480–489PubMedCrossRef Hermans G, Wilmer A, Meersseman W et al (2007) Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit. Am J Respir Crit Care Med 175:480–489PubMedCrossRef
13.
Zurück zum Zitat Van den Berghe G, Wilmer A, Milants I et al (2006) Intensive insulin therapy in mixed medical/surgical ICU: benefit versus harm. Diabetes 55:3151–3159PubMedCrossRef Van den Berghe G, Wilmer A, Milants I et al (2006) Intensive insulin therapy in mixed medical/surgical ICU: benefit versus harm. Diabetes 55:3151–3159PubMedCrossRef
14.
Zurück zum Zitat Furnary AP, Gao G, Grunkemeier GL et al (2003) Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 125:1007–1021PubMedCrossRef Furnary AP, Gao G, Grunkemeier GL et al (2003) Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 125:1007–1021PubMedCrossRef
15.
Zurück zum Zitat Furnary AP, Wu Y (2006a) Clinical effects of hyperglycemia in the cardiac surgery population: the Portland Diabetic Project. Endocr Pract 12:22–26PubMed Furnary AP, Wu Y (2006a) Clinical effects of hyperglycemia in the cardiac surgery population: the Portland Diabetic Project. Endocr Pract 12:22–26PubMed
16.
Zurück zum Zitat Furnary AP, Wu Y (2006b) Eliminating the diabetic disadvantage: the Portland Diabetic Project. Semin Thorac Cardiovasc Surg 18:302–308PubMedCrossRef Furnary AP, Wu Y (2006b) Eliminating the diabetic disadvantage: the Portland Diabetic Project. Semin Thorac Cardiovasc Surg 18:302–308PubMedCrossRef
17.
Zurück zum Zitat Malmberg K (1997) Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ 314:1512–1515PubMed Malmberg K (1997) Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ 314:1512–1515PubMed
18.
Zurück zum Zitat Malmberg K, Ryden L, Hamsten A, Herlitz J, Waldenstrom A, Wedel H (1996) Effects of insulin treatment on cause-specific one-year mortality and morbidity in diabetic patients with acute myocardial infarction. DIGAMI Study Group. Diabetes Insulin-Glucose in Acute Myocardial Infarction. Eur Heart J 17:1337–1344PubMed Malmberg K, Ryden L, Hamsten A, Herlitz J, Waldenstrom A, Wedel H (1996) Effects of insulin treatment on cause-specific one-year mortality and morbidity in diabetic patients with acute myocardial infarction. DIGAMI Study Group. Diabetes Insulin-Glucose in Acute Myocardial Infarction. Eur Heart J 17:1337–1344PubMed
19.
Zurück zum Zitat Scott JF, Robinson GM, French JM et al (1999) Glucose potassium insulin infusions in the treatment of acute stroke patients with mild to moderate hyperglycemia: the Glucose Insulin in Stroke Trial (GIST). Stroke 30:793–799PubMed Scott JF, Robinson GM, French JM et al (1999) Glucose potassium insulin infusions in the treatment of acute stroke patients with mild to moderate hyperglycemia: the Glucose Insulin in Stroke Trial (GIST). Stroke 30:793–799PubMed
20.
Zurück zum Zitat Ellger B, Debaveye Y, Vanhorebeek I et al (2006) Survival benefits of intensive insulin therapy in critical illness. Impact of normoglycemia versus glycemia-independent actions of insulin. Diabetes 55:1096–1105PubMedCrossRef Ellger B, Debaveye Y, Vanhorebeek I et al (2006) Survival benefits of intensive insulin therapy in critical illness. Impact of normoglycemia versus glycemia-independent actions of insulin. Diabetes 55:1096–1105PubMedCrossRef
21.
Zurück zum Zitat Van den Berghe G, Wouters PJ, Bouillon R et al (2003) Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 31:359–366PubMedCrossRef Van den Berghe G, Wouters PJ, Bouillon R et al (2003) Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 31:359–366PubMedCrossRef
22.
Zurück zum Zitat Vanhorebeek I, De Vos R, Mesotten D et al (2005) Strict blood glucose control with insulin in critically ill patients protects hepatocytic mitochondrial ultrastructure and function. Lancet 365:53–59PubMedCrossRef Vanhorebeek I, De Vos R, Mesotten D et al (2005) Strict blood glucose control with insulin in critically ill patients protects hepatocytic mitochondrial ultrastructure and function. Lancet 365:53–59PubMedCrossRef
23.
Zurück zum Zitat Langouche L, Vanhorebeek I, Vlasselaers D et al (2005) Intensive insulin therapy protects the endothelium of critically ill patients. J Clin Invest 115:2277–2286PubMedCrossRef Langouche L, Vanhorebeek I, Vlasselaers D et al (2005) Intensive insulin therapy protects the endothelium of critically ill patients. J Clin Invest 115:2277–2286PubMedCrossRef
24.
Zurück zum Zitat Weekers F, Giuletti A-P, Michalaki M et al (2003) Endocrine and immune effects of stress hyperglycemia in a rabbit model of prolonged critical illness. Endocrinology 144:5329–5338PubMedCrossRef Weekers F, Giuletti A-P, Michalaki M et al (2003) Endocrine and immune effects of stress hyperglycemia in a rabbit model of prolonged critical illness. Endocrinology 144:5329–5338PubMedCrossRef
25.
Zurück zum Zitat Mesotten D, Swinnen JV, Vanderhoydonc F et al (2004) Contribution of circulating lipids to the improved outcome of critical illness by glycemic control with intensive insulin therapy. J Clin Endocrinol Metab 89:219–226PubMedCrossRef Mesotten D, Swinnen JV, Vanderhoydonc F et al (2004) Contribution of circulating lipids to the improved outcome of critical illness by glycemic control with intensive insulin therapy. J Clin Endocrinol Metab 89:219–226PubMedCrossRef
26.
Zurück zum Zitat Hansen TK, Thiel S, Wouters PJ et al (2003) Intensive insulin therapy exerts anti-inflammatory effects in critically ill patients, as indicated by circulating mannose-binding lectin and C-reactive protein levels. J Clin Endocrinol Metab 88:1082–1088PubMedCrossRef Hansen TK, Thiel S, Wouters PJ et al (2003) Intensive insulin therapy exerts anti-inflammatory effects in critically ill patients, as indicated by circulating mannose-binding lectin and C-reactive protein levels. J Clin Endocrinol Metab 88:1082–1088PubMedCrossRef
27.
Zurück zum Zitat Vanhorebeek I, Peeters RP, Vander Perre S et al (2006) Cortisol response to critical illness: effect of intensive insulin therapy. J Clin Endocrinol Metab 91:3803–3813PubMedCrossRef Vanhorebeek I, Peeters RP, Vander Perre S et al (2006) Cortisol response to critical illness: effect of intensive insulin therapy. J Clin Endocrinol Metab 91:3803–3813PubMedCrossRef
28.
Zurück zum Zitat Van Cromphaut S, Wilmer A, Van den Berghe G (2007) Management of sepsis. N Engl J Med 356:1179–1181; author reply 1181–1182PubMed Van Cromphaut S, Wilmer A, Van den Berghe G (2007) Management of sepsis. N Engl J Med 356:1179–1181; author reply 1181–1182PubMed
29.
Zurück zum Zitat Vriesendorp TM, DeVries JH, van Santen S et al (2006) Evaluation of short-term consequences of hypoglycemia in an intensive care unit. Crit Care Med 34:26714–2718 Vriesendorp TM, DeVries JH, van Santen S et al (2006) Evaluation of short-term consequences of hypoglycemia in an intensive care unit. Crit Care Med 34:26714–2718
30.
Zurück zum Zitat Mackenzie I, Ingle S, Zaidi S et al (2006) Hypoglycemia? So what! Intensive Care Med 32:620–621CrossRef Mackenzie I, Ingle S, Zaidi S et al (2006) Hypoglycemia? So what! Intensive Care Med 32:620–621CrossRef
31.
Zurück zum Zitat Finney SJ, Zekveld C, Elia A et al (2003) Glucose control and mortality in critically ill patients. J Am Med Assoc 290:2041–2047CrossRef Finney SJ, Zekveld C, Elia A et al (2003) Glucose control and mortality in critically ill patients. J Am Med Assoc 290:2041–2047CrossRef
32.
Zurück zum Zitat Langouche L, Vander Perre S, Wouters P, D’Hoore A, Hansen TK, Van den Berghe G (2007) Effect of intensive insulin therapy on insulin sensitivity in the critically ill. J Clin Endocrinol Metab 92:3890–3897PubMedCrossRef Langouche L, Vander Perre S, Wouters P, D’Hoore A, Hansen TK, Van den Berghe G (2007) Effect of intensive insulin therapy on insulin sensitivity in the critically ill. J Clin Endocrinol Metab 92:3890–3897PubMedCrossRef
33.
34.
Zurück zum Zitat Jolliet P, Pichard C, Biolog G et al (1998) Enteral nutrition in intensive care patients: a practical approach. Intensive Care Med 24:848–859PubMedCrossRef Jolliet P, Pichard C, Biolog G et al (1998) Enteral nutrition in intensive care patients: a practical approach. Intensive Care Med 24:848–859PubMedCrossRef
Metadaten
Titel
Insulin therapy in the intensive care unit should be targeted to maintain blood glucose between 4.4 mmol/l and 6.1 mmol/l
verfasst von
G. Van den Berghe
Publikationsdatum
01.06.2008
Verlag
Springer-Verlag
Erschienen in
Diabetologia / Ausgabe 6/2008
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-007-0878-7

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