Table 1.
Summary data of selected randomized controlled trials of intensive insulin therapy in critically ill patients (>200 randomized patients)a
| Trial | N | Setting | Blood glucose target [mg/dl (mmol/l)] |
Blood glucose achieved [mg/dl (mmol/l)]b |
Primary outcome | End point rate (%) |
ARR (%)c | RRR (%)c | Odds ratio (95% CI) | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Intensive | Conventional | Intensive | Conventional | Intensive | Conventional | |||||||
| DIGAMI (ref. 33), 1995 | 620 | CCU (AMI) | 126–196 (7–10.9) | Usual care | 173 (9.6) | 211 (11.7) | 1-year mortality | 18.6 | 26.1 | 7.5 | 29d | NR |
| Van den Berghe et al. (ref. 5), 2001 | 1,548 | SICU | 80–110 (4.4–6.1) | 180–200 (10–11) | 103 (5.7) | 153 (8.5) | ICU mortality | 4.6 | 8.0 | 3.4 | 42 | 0.58(0.38–0.78)d |
| DIGAMI 2 (ref. 34), 2005 | 1,253 | CCU (AMI) | 126–180 (7–10) (groups 1 and 2) | Usual care (group 3) | 164 (9.1) | 180 (10) | 2-year mortality | Group 1, 23.4; group 2, 21.2 | Group 3, 17.9 | —e | —e | NR |
| Van den Berghe et al. (ref. 16), 2006 | 1,200 | MICU | 80–110 (4.4–6.1) | 180–200 (10–11) | 111 (6.2) | 153 (8.5) | Hospital mortality | 37.3 | 40.0 | 2.7 | 7.0 | 0.94(0.84–1.06)e |
| HI-5 (ref. 35), 2006 | 240 | CCU (Ami) (GIK) | 72–180 (4–10) | Usual care <288 | 149 (8.3) | 162 (9) | 6-month mortality | 7.9 | 6.1 | −1.8e | −30e | NR |
| GluControl (ref. 27), 2007f | 1,101 | ICU | 80–110 (4.4–6.1) | 140–180 (7.8–10) | 118 (6.5) | 144 (8) | ICU mortality | 16.7 | 15.2 | −1.5 | −10 | 1.10(0.84–1.44)e |
| Gandhi et al. (ref. 36), 2007 | 399 | Operating room | 80–110 (4.4–6.1) | <200 (<11) | 114 (6.3) | 157 (8.7) | Compositeg | 44 | 46 | 2 | 4.3 | 1.0(0.8–1.2)e |
| VISEP (ref. 13), 2008 | 537h | ICU | 80–110 (4.4–6.1) | 180–200 (10–11) | 112 (6.2) | 151 (8.4) | 28-day mortality | 24.7 | 26.0 | 1.3 | 5.0 | 0.89(0.58–1.38)e,i |
| De La Rosa et al. (ref. 28), 2008f | 504 | SICU MICU | 80–110 (4.4–6.1) | 180–200 (10–11) | 117 (6.5) | 148 (8.2) | 28-day mortality | 36.6 | 32.4 | −4.2e | −13e | NR |
| NICE-SUGAR (ref. 14), 2009 | 6,104 | ICU | 81–108 (4.5–6) | ≤180 (≤10) | 115 (6.4) | 145 (8.0) | 3-month mortality | 27.5 | 24.9 | −2.6 | −10.6 | 1.14(1.02–1.28)d |
aARR, absolute risk reduction; CCU, coronary care unit; GIK, glucose-insulin-potassium; MICU, medical ICU; NR, not reported; RRR, relative risk reduction; SICU, surgical ICU.
bMean morning blood glucose concentrations (except for GluControl, which reported mean overall blood glucose concentrations).
cIntensive group versus conventional group.
dP< 0.05.
eNot significant (P> 0.05).
fPresented as abstract only.
gComposite of death, sternal infection, prolonged ventilation, cardiac arrhythmias, stroke, and renal failure at 30 days.
hOnly patients with sepsis.
iPersonal communication, Dr. Frank Brunkhorst.