OBJECTIVE The purpose of this study was to analyze the economic outcomes of a clinical program implemented to achieve strict glycemic control with intensive insulin therapy in patients admitted to the intensive care unit (ICU). RESEARCH DESIGN AND METHODS A difference-in-differences (quasi-experimental) study design was used to examine the associations of an intensive insulin therapy interven...

Intervention: On admission, patients were randomly assigned to strict normalization of blood glucose levels (80 to 110 mg per deciliter [4.4 to 6.1 mmol per liter]) with the use of insulin infusion or to conventional therapy (insulin administered when the blood glucose level exceeded 215 mg per deciliter [12 mmol per liter], with the infusion tapered when the level fell below 180 mg per decilit...

Our aim was to investigate the effects of glycemic control and insulin concentration on lipolysis, glucose, and protein metabolism in critically ill medical patients. For our methods, the patients were studied twice. In study 1, blood glucose (BG) concentrations were maintained between 7 and 9 mmol/l with intravenous insulin. After study 1, patients entered one of four protocols for 48 h until ...

BACKGROUND The benefits and harms of intensive insulin therapy (IIT) titrated to strict glycemic targets in hospitalized patients remain uncertain. PURPOSE To evaluate the benefits and harms of IIT in hospitalized patients. DATA SOURCES MEDLINE and Cochrane Database of Systematic Reviews from 1950 to January 2010, reference lists, experts, and unpublished sources. STUDY SELECTION English-...

AIMS Hypoglycemia is a severe side effect of intensive insulin therapy. Recurrent hypoglycemia (RH) impairs the counter-regulatory response (CRR) which restores euglycemia. During hypoglycemia, ventromedial hypothalamus (VMH) production of nitric oxide (NO) and activation of its receptor soluble guanylyl cyclase (sGC) are critical for the CRR. Hypoglycemia also increases brain reactive oxygen s...

objective: serum leptin concentration reflects the body fat mass. there is controversial reports about the insulin effect on serum leptin concentration. we wanted to examine the effect of insulin therapy on serum leptin in children with new onset type i diabetes. materials and methods: this was a cross-sectional study in children's medical center on 34 children who had new onset type i dia...

INTRODUCTION Hyperglycemia represents an independent prognostic factor in critically ill non-diabetic patients but not in those with diabetes. In this context, there is an ongoing debate on the benefit of an intensive insulin therapy, particularly in diabetic patients. We tested the hypothesis that expression of the receptor for advanced glycation end-products (RAGE), an important signal transd...

Interest in the effects of insulin on the heart came with the recognition that hyperglycemia in the context of myocardial infarction is associated with increased risks of mortality, congestive heart failure, or cardiogenic shock.1–3 More recently, instigated by research findings on stress hyperglycemia in critical illness, this interest has been extended to the influence of insulin on clinical ...

served in patients admitted to the hospital. An estimated 13 million Americans have a known diagnosis of diabetes, with type 2 diabetes accounting for 90% to 95% of all diagnosed cases. An additional 5.2 million Americans have diabetes but are unaware of their condition.1 The rising prevalence of diabetes is leading to an increasing number of hospital admissions for the management of cardiovasc...

BACKGROUND A recently halted clinical trial showed that intensive treatment of type 2 diabetes mellitus was associated with increased mortality. Given the phenotypic heterogeneity of diabetes, therapy targeted at insulin status may maximize benefits and minimize harm. METHODS In this longitudinal cohort study, we followed 503 patients with type 2 diabetes who were free of cardiovascular disea...