Intensive insulin therapy versus conventional glycemic control in patients with acute neurological injury: a prospective controlled trial

Objective

To compare intensive insulin therapy with conventional glycemic control in patients with acute neurological injury, evaluating neurological outcome and morbi-mortality.

Methods

Patients with two glycemias above 150 mg/dl 12 hours after admission were randomized to receive intensive insulin therapy (G1) or conventional treatment (G2). We evaluated a subgroup of patients with acute brain injury from July 2004 to June 2006.

Results

G1 patients (n = 31) received 70.5 (45.1–87.5) units insulin/day while G2 patients (n = 19) received 2 (0.6–14.1) units/day (P < 0.0001). The median glycemia was comparable in both groups (P = 0.16). Hypoglycemia occurred in two patients (6.4%) in G1 and in one patient (5.8%) in G2 (P = 1.0). Mortality in G1 was 25.8%, and it was 35.2% in G2 (relative reduction of 27%). Neurological outcome was similar in both groups.

Conclusion

A less strict intensive insulin therapy can reduce hypoglycemia and still maintain its benefits.