Intensive Insulin Therapy in Hospitalized Patients
Authors: Anthony P. Furnary
Journal: Annals of Internal Medicine (2011)

Letters21 June 2011Intensive Insulin Therapy in Hospitalized PatientsAnthony P. Furnary, MDAnthony P. Furnary, MDFrom Starr-Wood Cardiac Group, Portland, OR 97225-6029.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-12-201106210-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I read with interest Qaseem and colleagues' clinical practice guideline on intensive insulin therapy (IIT) (1). For diabetic patients who have undergone coronary artery bypass grafting (CABG), recommendations 2 and 3 are unfounded and not supported by the data cited.Only 2 of the 14 randomized, controlled trials (RCTs) evaluated in the meta-analysis (2, 3) included patients who had undergone CABG. In both of these trials, IIT-directed tight glycemic control (TGC) statistically significantly reduced in-hospital mortality and surgical wound infection rates. All of the remaining studies that were evaluated in the meta-analysis excluded patients who had undergone ...References1. Qaseem A, Humphrey LL, Chou R, Snow V, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Use of intensive insulin therapy for the management of glycemic control in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2011;154:260-7. [PMID: 21320941] LinkGoogle Scholar2. Kirdemir P, Yildirim V, Kiris I, Gulmen S, Kuralay E, Ibrisim E, et al. Does continuous insulin therapy reduce postoperative supraventricular tachycardia incidence after coronary artery bypass operations in diabetic patients? J Cardiothorac Vasc Anesth. 2008;22:383-7. [PMID: 18503925] CrossrefMedlineGoogle Scholar3. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359-67. [PMID: 11794168] CrossrefMedlineGoogle Scholar4. Furnary AP, Zerr KJ, Grunkemeier GL, Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg. 1999;67:352-60. [PMID: 10197653] CrossrefMedlineGoogle Scholar5. Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, et al. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125:1007-21. [PMID: 12771873] CrossrefMedlineGoogle Scholar6. Vanhorebeek I, Ingels C, Van den Berghe G. Intensive insulin therapy in high-risk cardiac surgery patients: evidence from the Leuven randomized study. Semin Thorac Cardiovasc Surg. 2006;18:309-16. [PMID: 17395027] CrossrefMedlineGoogle Scholar7. Bilotta F, Caramia R, Paoloni FP, Delfini R, Rosa G. Safety and efficacy of intensive insulin therapy in critical neurosurgical patients. Anesthesiology. 2009;110:611-9. [PMID: 19237874] CrossrefMedlineGoogle Scholar8. Furnary A, Wu YX. Glycemic control in the hospital: evidence, issues, and future directions—the Portland studies. Presented at the American Association for Clinical Chemistry 2011 Arnold O Beckman Conference, San Diego, California, 12–13 April 2011. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Starr-Wood Cardiac Group, Portland, OR 97225-6029.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoUse of Intensive Insulin Therapy for the Management of Glycemic Control in Hospitalized Patients: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Linda L. Humphrey , Roger Chou , Vincenza Snow , Paul Shekelle , and Intensive Insulin Therapy in Hospitalized Patients Rajesh Garg Intensive Insulin Therapy in Hospitalized Patients Mary Korytkowski , Etie Moghissi , and Guillermo Umpierrez Intensive Insulin Therapy in Hospitalized Patients Devan Kansagara , Paul Shekelle , and Amir Qaseem Intensive Insulin Therapy in Hospitalized Patients Lynn Bentson Metrics Cited ByDiabetes in Older AdultsDiabetes in Older AdultsStress Hyperglycemia During Surgery and Anesthesia: Pathogenesis and Clinical ImplicationsManagement of Hyperglycemia During the Perioperative Period 21 June 2011Volume 154, Issue 12Page: 845-846KeywordsBloodCardiac surgeryGlucoseHyperglycemiaHypoglycemiaInsulinIntensive care unitsTreatment guidelines ePublished: 21 June 2011 Issue Published: 21 June 2011 CopyrightCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...