Implementation of intensive insulin therapy improves glycaemic control in patients managed with conventional insulin therapy

Introduction

The implementation of intensive insulin therapy in the critically ill has recently been shown to improve morbidity and mortality [1, 2].

Patients and methods

We have performed a prospective observational study to assess the effects, on all patients, of the first 6 months of an intensive insulin therapy protocol. We have studied 91 patients staying in critical care > 48 hours. This extended to 1233 patient-days and 7987 individual sugar estimations. For intensive insulin therapy blood sugars were maintained between 4 and 7 mmol/l.

Results

Fifty-two patients received intensive insulin therapy during their admission, 39 did not. The demographics of the two groups were well matched. The impact of the institution of the protocol was assessed in two 3-month blocks. The mean blood glucose in the intensive insulin therapy group was significantly lower than the conventional therapy group (P < 0.0001, unpaired t test). Glycaemic control failed to improve in the second 3 months in the intensive therapy group (Table 1). There was a significant reduction in blood sugars in the second 3 months for conventional control (Table 1).

Table 1

Conclusions

Intensive insulin therapy resulted in sugar control comparable with that published previously [2]. Sugar control in the conventional group improved over the study period. This may be due to the increased awareness of the importance of sugar control. Use of intensive insulin therapy may lead to better sugar control and improved morbidity and mortality in all patients, regardless of the insulin therapy protocol used.