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Báo cáo y học: " Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy? | Available online http ccforum.eom content 13 2 302 Viewpoint Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy Moritoki Egi1 Rinaldo Bellomo2 and Michael C Reade2 1 Department of Anesthesiology and Resuscitology Okayama University Hospital Shikata City Japan 700-8558 2Department of Intensive Care Austin Hospital Melbourne 145 Studley Road Heidelberg Victoria Australia 3084 Corresponding author Rinaldo Bellomo rinaldo.bellomo@austin.org.au Published 6 April 2009 This article is online at http ccforum.com content 13 2 302 2009 BioMed Central Ltd Critical Care 2009 13 302 doi 10.1186 cc7755 Abstract Since the first report that intensive insulin therapy reduced mortality in selected surgical critically ill patients lowering of blood glucose levels has been recommended as a means of improving patient outcomes. In this initial Leuven trial blood glucose control by protocol using insulin was applied to 98.7 of patients in the intensive group but to only 39.2 P 0.0001 of patients in the control group. If appropriately applied such protocols should decrease both the mean blood glucose concentration and its variability variation of blood glucose concentration . Thus it is logically possible that the benefit of intensive insulin therapy in the first Leuven trial was due to a decrease in mean glucose levels a decrease in their variability or both. Several recent studies have confirmed significant associations between variability of blood glucose levels and patient outcomes. Decreasing the variability of blood glucose levels might be an important dimension of glucose management a possible mechanism by which an intensive insulin protocol exerts its putative beneficial effects and an important goal of glucose management in the intensive care unit. Clinicians need to be aware of this controversy when considering the application of intensive insulin therapy and interpreting future trials. Intensive insulin therapy Acute hyperglycemia .