Intensive insulin therapy versus conventional glycemic control in patients with acute neurological injury - A prospective controlled trial

Objective: To compare intensive insulin therapy to conventional glycemic control in patients with acute neurological injury evaluating neurological outcome and morbimortality. Method., Patients with two glycemias above 150 mg/dL 12 hours after admission were randomized to receive intensive insulin therapy (G1) or conventional treatment (G2). We evaluated a subgroup of patients with acute brain injury from July, 2004 to June, 2006. Results: G1 patients (n=31) received 70.5 (45.1-87.5) units of insulin/ day while G2 patients (n=19) received 2 (0.6-14.1) units/day (p < 0.0001). The median glycemia was comparable in both groups (p=0.16). Hypoglycemia occurred in 2 patients (6.4%) in G1 and in 1 patient (5.8%) in G2 (p=1.0). Mortality in G1 was of 25.8% and of 35.2% in G2 (relative reduction of 27%). Neurological outcome was similar in both groups. Conclusion: A less strict intensive insulin therapy can reduce hypoglycemia and still maintain its benefits.