Intensive insulin therapy reduced morbidity but not mortality in patients in the medical intensive care unit.

M e t h o d s Design: Randomized controlled trial. Allocation: {Concealed}†.* Blinding: Blinded (primary outcome assessors and data analysts). Follow-up period: Until hospital discharge. Setting: A medical ICU in Leuven, Belgium. Patients: 1200 medical patients (mean age 64 y, 62% men) admitted to the medical ICU who were assumed to require at least 3 days of intensive care. Patients were excluded if they were surgical patients, medical patients with do-not-resuscitate orders, or able to receive oral nutrition. Intervention: Intensive insulin therapy (n = 595) or conventional insulin therapy (n = 605). For intensive therapy, insulin was given when blood glucose levels were > 110 mg/dL (6.1 mmol/L), and then adjusted to maintain 80 to 110 mg/dL (4.4 to 6.1 mmol/L). For conventional therapy, insulin was given when blood glucose levels were > 215 mg/dL (12 mmol/L), and then adjusted to maintain 180 to 200 mg/dL (10 to 11 mmol/L). When blood glucose levels fell below 180 mg/dL, the infusion was tapered or stopped. Outcomes: In-hospital mortality. Secondary outcomes included ICU and 90-day mortality, new kidney injury (serum creatinine level > 2.5 mg/dL [220 μmol/L] or 2 times baseline), days to weaning from mechanical ventilation, duration of ICU and hospital stay, readmission to ICU, presence of bacteremia, and prolonged (> 10 d) antibiotic use. Patient follow-up: 100% (intention-to-treat analysis).