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BioMed Research International
Volume 2014, Article ID 698265, 10 pages
http://dx.doi.org/10.1155/2014/698265
Review Article

Intensive Insulin Therapy for Septic Patients: A Meta-Analysis of Randomized Controlled Trials

1School of Medicine, Zhejiang University, Yuhangtang Road 866, Hangzhou 310058, China
2Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, China
3Department of Surgical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 310003, China
4Department of Surgery, Children’s Hospital, School of Medicine, Zhejiang University, Zhuganxiang 57, Hangzhou 310003, China

Received 7 January 2014; Accepted 18 March 2014; Published 18 June 2014

Academic Editor: Baoli Cheng

Copyright © 2014 Fang Song et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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], ), 28-day mortality (RR = 0.66, 95% CI [0.40, 1.10], ), 90-day mortality (RR = 1.10, 95% CI [0.97, 1.26], ), ICU mortality (RR = 0.94, 95% CI [0.77, 1.14], ), hospital mortality (RR = 0.98, 95% CI [0.86, 1.11], ), 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], ). Conclusions. For patients with sepsis, IIT and conservative glucose management show similar efficacy, but ITT is associated with a higher incidence of hypoglycemia.