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Review
. 2014:2014:698265.
doi: 10.1155/2014/698265. Epub 2014 Jun 18.

Intensive insulin therapy for septic patients: a meta-analysis of randomized controlled trials

Fang Song  1 , Liu-Jun Zhong  2 , Liang Han  2 , Guo-Hao Xie  2 , Cheng Xiao  3 , Bing Zhao  2 , Yao-Qin Hu  4 , Shu-Yan Wang  2 , Chao-Jin Qin  4 , Yan Zhang  2 , Deng-Ming Lai  4 , Ping Cui  2 , Xiang-Ming Fang  2
Affiliations
Review

Intensive insulin therapy for septic patients: a meta-analysis of randomized controlled trials

Fang Song et al. Biomed Res Int. 2014.

Abstract

Background. Studies on the effect of intensive insulin therapy (IIT) in septic patients with hyperglycemia have given inconsistent results. The primary purpose of this meta-analysis was to evaluate whether it is effective in reducing mortality. Methods. We searched PubMed, Embase, the Cochrane Library, clinicaltrials.gov, and relevant reference lists up to September 2013 and including randomized controlled trials that compared IIT with conventional glucose management in septic patients. Study quality was assessed using the Cochrane Risk of Bias Tool. And our primary outcome measure was pooled in the random effects model. Results. We identified twelve randomized controlled trials involving 4100 patients. Meta-analysis showed that IIT did not reduce any of the outcomes: overall mortality (risk ratio [RR] = 0.98, 95% CI [0.85, 1.15], P = 0.84), 28-day mortality (RR = 0.66, 95% CI [0.40, 1.10], P = 0.11), 90-day mortality (RR = 1.10, 95% CI [0.97, 1.26], P = 0.13), ICU mortality (RR = 0.94, 95% CI [0.77, 1.14], P = 0.52), hospital mortality (RR = 0.98, 95% CI [0.86, 1.11], P = 0.71), severity of illness, and length of ICU stay. Conversely, the incidence of hypoglycemia was markedly higher in the IIT (RR = 2.93, 95% CI [1.69, 5.06], P = 0.0001). Conclusions. For patients with sepsis, IIT and conservative glucose management show similar efficacy, but ITT is associated with a higher incidence of hypoglycemia.

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Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Forest plot with all-cause mortality showing no significant difference between IIT and control group (RR = 0.98, 95% CI [0.85, 1.15]). IIT: intensive insulin therapy. CI: confidence interval. M-H: Mantel-Haenszel.
Figure 3
Figure 3
Meta-analysis showing no significant difference between IIT and control groups, with mortality being stratified into 28-day, 90-day, ICU, and hospital mortality. IIT: intensive insulin therapy. CI: confidence interval. M-H: Mantel-Haenszel.
Figure 4
Figure 4
Forest plot with severity of illness showing no significant difference between IIT and control groups in SOFA, APACHE II, and SAPS II scores, with a reduction of MODS score with IIT. IIT: intensive insulin therapy. SD: standard deviation. CI: confidence interval. IV: inverse variance.
Figure 5
Figure 5
Forest plot showing that IIT increased the risk of hypoglycemia. IIT: intensive insulin therapy. CI: confidence interval. M-H: Mantel-Haenszel.
See this image and copyright information in PMC

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