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Cited by 554Hyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Management and ResearchClinical Nutrition and Gastroenterology

Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study

Vlasselaers, Dirk, Milants, Ilse, Desmet, Lars, Wouters, Pieter J, Vanhorebeek, Ilse, van den Heuvel, Ingeborg, Mesotten, Dieter, Casaer, Michael P +6 more·2009·The Lancet
DOI 10.1016/s0140-6736(09)60044-1
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Abstract

Background Critically ill infants and children often develop hyperglycaemia, which is associated with adverse outcome; however, whether lowering blood glucose concentrations to age-adjusted normal fasting values improves outcome is unknown. We investigated the effect of targeting age-adjusted normoglycaemia with insulin infusion in critically ill infants and children on outcome.Methods In a prospective, randomised controlled study, we enrolled 700 critically ill patients, 317 infants (aged <1 year) and 383 children (aged >or=1 year), who were admitted to the paediatric intensive care unit (PICU) of the University Hospital of Leuven, Belgium. Patients were randomly assigned by blinded envelopes to target blood glucose concentrations of 2.8-4.4 mmol/L in infants and 3.9-5.6 mmol/L in children with insulin infusion throughout PICU stay (intensive group [n=349]), or to insulin infusion only to prevent blood glucose from exceeding 11.9 mmol/L (conventional group [n=351]). Patients and laboratory staff were blinded to treatment allocation. Primary endpoints were duration of PICU stay and inflammation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00214916.Findings Mean blood glucose concentrations were lower in the intensive group than in the conventional group (infants: 4.8 [SD 1.2] mmol/L vs 6.4 [1.2] mmol/L, p<0.0001; children: 5.3 [1.1] mmol/L vs 8.2 [3.3] mmol/L, p<0.0001). Hypoglycaemia (defined as blood glucose <or=2.2 mmol/L) occurred in 87 (25%) patients in the intensive group (p<0.0001) versus five (1%) patients in the conventional group; hypoglycaemia defined as blood glucose less than 1.7 mmol/L arose in 17 (5%) patients versus three (1%) (p=0.001). Duration of PICU stay was shortest in the intensively treated group (5.51 days [95% CI 4.65-6.37] vs 6.15 days [5.25-7.05], p=0.017). The inflammatory response was attenuated at day 5, as indicated by lower C-reactive protein in the intensive group compared with baseline (-9.75 mg/L [95% CI -19.93 to 0.43] vs 8.97 mg/L [-0.9 to 18.84], p=0.007). The number of patients with extended (>median) stay in PICU was 132 (38%) in the intensive group versus 165 (47%) in the conventional group (p=0.013). Nine (3%) patients died in the intensively treated group versus 20 (6%) in the conventional group (p=0.038).Interpretation Targeting of blood glucose concentrations to age-adjusted normal fasting concentrations improved short-term outcome of patients in PICU. The effect on long-term survival, morbidity, and neurocognitive development needs to be investigated.Funding Research Foundation (Belgium); Research Fund of the University of Leuven (Belgium) and the EU Information Society Technologies Integrated project "CLINICIP"; and Institute for Science and Technology (Belgium).

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Crossref · 10.1016/s0140-6736(09)60044-1

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  • Further reduction of T3 is associated with improving patient mortality rates.

    “Further statistical analysis showed that the further reduction of T3 was associated with improving patient mortality rates [92, 93].”

    From An update on non-thyroidal illness syndrome (2021) · cites this paper as [92]

  • Targeting fasting blood glucose concentrations with intensive insulin treatment in children with critical illness to values mimicking a fasting response results in improved outcomes but aggravates peripheral NTIS.

    “targeting of fasting blood glucose concentrations with intensive insulin treatment in children with critical illness to values mimicking a fasting response, resulted in improved outcomes, but at the same time aggravated peripheral NTIS.”

    From An update on non-thyroidal illness syndrome (2021) · cites this paper as [92]

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Authors
Vlasselaers, D., Milants, I., Desmet, L., Wouters, P. J., Vanhorebeek, I., van den Heuvel, I., Mesotten, D., Casaer, M. P., Meyfroidt, G., Ingels, C., Muller, J., Van Cromphaut, S., Schetz, M., & Van den Berghe, G.
Affiliations
KU Leuven (BE)
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2009-02
Volume
373
Issue
9663
Pages
547-556
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(09)60044-1
OpenAlex
W2153316233
Cited by
554
References
36
Citations by year
2026: 10 · 2025: 14 · 2024: 12 · 2023: 10 · 2022: 15 · 2021: 17 · 2020: 14 · 2019: 20 · 2018: 25 · 2017: 27 · 2016: 33 · 2015: 43 · 2014: 50 · 2013: 44 · 2012: 53
FWCI
52.69
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Keywords
intensive insulin therapy, glycemic control, hyperglycemia, critically ill infants, critically ill children, pediatric intensive care, hypoglycemia, mortality, PICU length of stay, inflammation
MeSH terms
Adolescent, Belgium, Blood Glucose, Child, Child, Preschool, Critical Care, Female, Humans, Hypoglycemia, Hypoglycemic Agents, Infant, Infant, Newborn, Insulin, Length of Stay, Male, Prospective Studies, Intensive Care Units, Pediatric, Hospital Mortality

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