A carbohydrate-restrictive strategy is safer and as efficient as intensive insulin therapy in critically ill patients

Abstract

Purpose The aim of this study is to compare the safety and efficacy of 2 different strategies for glycemic control in critically ill adult patients. Materials and Methods A total of 337 patients were randomly assigned to a carbohydrate-restrictive strategy (group 1) through glucose-free venous hydration, hypoglycidic nutritional formula, and subcutaneous insulin if blood glucose level was higher than 180 mg/dL or to strict normalization of blood glucose levels (80-120 mg/dL) with the use of insulin infusion (group 2). Results Patients in group 1 (n = 169) received 2 (0-6.5) units of regular insulin per day, whereas patients in group 2 (n = 168) received 52 (35-74.5) units per day ( P < .001). The median blood glucose level was 144 mg/dL in group 1 and 133.6 mg/dL in group 2 ( P = .003). Hypoglycemia occurred in 6 (3.5%) patients in group 1 and 27 (16%) in group 2 ( P < .001) and was an independent risk factor for neurological dysfunction and mortality. Conclusions A carbohydrate-restrictive strategy reduced significantly the incidence of hypoglycemia in critically ill patients compared to intensive insulin therapy. Mortality and morbidity were comparable between the 2 groups.