OBJECTIVE To evaluate the clinical outcomes of glycemic control of intensive insulin therapy and recommend its place in the management of critically ill patients. DATA SOURCES Searches of MEDLINE (1966-March 2004) and Cochrane Library, as well as an extensive manual review of abstracts were performed using the key search terms hyperglycemia, insulin, intensive care unit, critically ill, outco...

Clinical trials have demonstrated that acute intensive insulin therapy causes a transient worsening of diabetic retinopathy in type 1 diabetes patients (1–5). The worsening results, in part, from hard exudates and macular edema — pathologies that are manifestations of blood-retinal barrier breakdown. However, continued intensive insulin therapy eventually leads to a marked reduction in the risk...

Background: Clinical treatment goals of type 1 diabetes mellitus (T1DM) have changed since the Diabetes Control and Complications Trial (DCCT) demonstrated reduced long-term complications with intensive diabetes therapy. There have been few longitudinal studies to describe the clinical course of T1DM in the age of intensive therapy. Our objective was to describe the currentday clinical course o...

Background: Clinical treatment goals of type 1 diabetes mellitus (T1DM) have changed since the Diabetes Control and Complications Trial (DCCT) demonstrated reduced long-term complications with intensive diabetes therapy. There have been few longitudinal studies to describe the clinical course of T1DM in the age of intensive therapy. Our objective was to describe the currentday clinical course o...

UNLABELLED Aims/Introduction:  Patients with type 1 diabetes mellitus often show a precipitous postprandial rise in blood glucose that cannot be controlled, even by intensive insulin therapy. The combined use of an α-glucosidase inhibitor with insulin seems to be highly beneficial in such cases. MATERIALS AND METHODS   We investigated the efficacy and safety of miglitol, an α-glucosidase inhi...

The prevalence of intensive insulin and restrictive blood use protocols in burn centers is unknown, which may be problematic as the combined impact of these therapies is to concomitantly increase the prevalence of anemia and hypoglycemia in intensive care unit patients. Such a development is important because point-of-care (POC) glucometers report erroneously high values in the presence of low ...

Recently, the concept that stress hyperglycemia in critically ill patients is an adaptive, beneficial response has been challenged. Two large randomized studies demonstrated that maintenance of normoglycemia with intensive insulin therapy substantially prevents morbidity and reduces mortality in these patients. Since then, questions have been raised about the efficacy in general and in specific...

• Life-threatening acute metabolic complications of diabetes. • Newly diagnosed diabetes in children and adolescents. • Substantial and chronic poor metabolic control that necessitates close monitoring of the patient to determine the etiology of the control problem, with subsequent modification of therapy. • Severe chronic complications of diabetes that require intensive treatment or other seve...