Hyperglycemia and insulin resistance are common in critically ill patients even if they did not have diabetes before their illnesses. Hyperglycemia in the intensive care unit (ICU) setting has been shown to be associated with an increased mortality, and restoration of nor-moglycemia using intensive insulin therapy has decreased mortality for the following populations:myocardial infarction, burn, and stroke. Specifically, in the surgical ICU setting, the use of intensive insulin therapy to achieve nor-moglycemia has resulted in a lower incidence of nosocomial infections.

The most compelling study by Van den Berghe et al. showed that, for hyperglycemic patients in the surgical ICU setting on the ventilator, intensive insulin therapy to achieve nor-moglycemia (80 to 110 mg/dL = 4.4 to 6.1 mmol/L) resulted in a 43% reduction in mortality (8% compared with 4.6%) when compared with patients treated with sliding scale insulin with the aim of achieving a glucose level between 180 and 200 mg/dL (10.0 to 11.1 mmol/L). The lowered mortality was largely accounted for in the group with an ICU stay of more than 5 days whose mortality from multiple organ failure was lowered. Additional outcomes associated with nor-moglycemia included fewer bacteremias, reduced requirement for hemodialysis, fewer transfusions, and shorter duration on the ventilator and in the ICU. Although their ICU population was skewed toward postoperative cardiac surgery patients, the-ICU-stay population in whom the mortality reduction was more striking, and therefore a better balanced group.