scholarly journals Intensive Insulin Therapy Versus Conventional Glucose Control In Traumatic Brain Injury Patients Who Are On Parenteral Nutrition

2020 ◽  
pp. 176-185
Author(s):  
Youmna M. Hassan ◽  
Hatem E. Mahmoud ◽  
Hazem A. Hussein
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Parenteral Nutrition ◽  
Insulin Therapy ◽  
Intensive Insulin Therapy ◽  
Glucose Control ◽  
University Hospital ◽  
Surgical Intensive Care Unit ◽  
Insulin Group ◽  
Glucose Levels

<p>Parenteral nutrition (PN) is a valuable life saving intervention, which can improve the nutritional status of hospitalized malnourished patients. PN is associated with complications including hyperglycemia. This study was conducted to compare two methods of blood glucose control in traumatic brain injury patients who are on PN.</p> <p><strong>Materials & Methods:</strong>This study is a randomized , open-label, controlled clinical trial with blinded end assessment. This study was done in the surgical intensive care unit of Beni-Suef University hospital after obtaining approval from the ethical committee of the Institution and obtaining consent from relatives of the patients involved in the study. Seventy critically ill patients were choosen randomly according to the inclusion criteria from cases admitted to Beni-suef university hospital, then divided into two groups randomly:</p> <p><strong>Group </strong><strong>?</strong><strong> (Intensive insulin therapy):</strong>35 patients received continuous insulin infusion to maintain glucose levels between 4.4mmol/l (80 mg/dl) and 6.6mmol/l (110 mg/dl).</p> <p><strong>Group </strong><strong>??</strong><strong> (Conventional therapy):</strong>35patients not received insulin unless glucose levels greater than 10 mmol/l (>180 mg/dl).</p> <p><strong>Results: </strong>In our study, it was shown that mean glucose concentration were significantly lower in IIT group vs conventional group. No hypoglycemic episode occurred in two groups. Triglyceride and C-reactive protein was decreased in the IIT group, significantly. There were also significant differences in the electrolytes, with magnesium and phosphorus being lower in the IIT group.</p> <p><strong>Conclusion:</strong> In this study, Intensive insulin group improved some of parenteral such as hyperglycemia, hypertriglyceridemia and electrolyte imbalances compared to Conventional insulin group.</p>

Intensive Insulin Therapy after Decompression Surgery for Severe Traumatic Brain Injury

2012 ◽  
Vol 8 (1) ◽  
pp. 44
Author(s):  
Moon Seok Kim ◽  
Seung Whan Lee ◽  
Seung-Ho Yang ◽  
Jae Taek Hong ◽  
Jae Hoon Sung ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Insulin Therapy ◽  
Severe Traumatic Brain Injury ◽  
Intensive Insulin Therapy ◽  
Decompression Surgery

scholarly journals Association between blood glucose levels in insulin therapy and Glasgow Outcome Score in patients with traumatic brain injury: secondary analysis of a randomized trial

2021 ◽  
Author(s):  
Tao Yuan ◽  
Hongyu He ◽  
Yuepeng Liu ◽  
Jianwei Wang ◽  
Xin Kang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Traumatic Brain Injury ◽  
Blood Glucose ◽  
Brain Injury ◽  
Blood Glucose Level ◽  
Insulin Therapy ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Medium Level ◽  
Level Group

Abstract Background: Too high or low blood glucose levels after traumatic brain injury (TBI) negatively affect the prognosis of patients with TBI. This study aimed to examine the relationship between different levels of blood glucose in insulin therapy and Glasgow Outcome Score (GOS) in patients with TBI.Methods: This study was based on a randomized, dual-center, open-label clinical trial. A total of 208 patients who participated in the randomized controlled trial were followed up for 5 years. The information on disease, lab examination, insulin therapy, and operation of patients with TBI was collected. Also, the data on 5-year and 6-month GOS were collected as primary and secondary outcomes. The univariate analysis was used to detect variables that might contribute to outcomes, while the multivariate regression analysis was used to reveal the independent relationship between insulin therapy and outcomes. A generalized additive model (GAM) was used to investigate dose–response relationships between blood glucose levels and GOS. The results were presented as odds ratios (ORs) with their 95% confidence intervals (95% CIs). We further applied a two-piecewise linear regression model to examine the threshold effect of blood glucose level and GOS.Results: A total of 182 patients were involved in the final analysis. Compared with the non-intensive insulin therapy group, the 5-year GOS in the moderate-control intensive insulin therapy (IIT) group and the slight-control IIT group was 1.45 and 1.39 higher, respectively (both P < 0.05); the 5-year GOS in the strict-control IIT group was 0.23 higher (P > 0.05). GAM revealed that a bell-shaped relationship existed between blood glucose levels in insulin therapy and 5-year or 6-month GOS. The inflection points of the mean blood glucose level were 6.73 and 8.97 mmol/L considering 5-year GOS as the outcome and were 6.95 and 8.88 mmol/L considering 6-month GOS as the outcome. The multivariate analysis showed that the 5-year GOS in the medium-level group (≥6.73 and <8.97 mmol/L) increased by 0.83 [95% confidence interval (CI): 0.22–1.47] compared with that in the low-level group (<6.73 mmol/L). Also, the 5-year GOS in the medium-level group increased by 0.57 (95% CI: 0.02–1.08) compared with that in the high-level group (≥8.97 mmol/L).Conclusion: A proper blood glucose range in insulin therapy could improve the outcomes of patients with TBI; the range was 6.73–8.97 mmol/L according to our limited analysis.Clinical Trial Registration: ClinicalTrials.gov, NCT02161055. Registered 11 Jun 2014.

scholarly journals Hyperglycemia in acutely ill emergency patients — Cause or effect?

CJEM ◽  
2006 ◽  
Vol 8 (05) ◽  
pp. 339-343 ◽  
Author(s):  
William R. Henderson ◽  
Dean R. Chittock ◽  
Vinay K. Dhingra ◽  
Juan J. Ronco
Keyword(s):  
Emergency Department ◽  
Insulin Therapy ◽  
Intensive Insulin Therapy ◽  
Glucose Control ◽  
Adverse Outcomes ◽  
Glucose Levels ◽  
Considerable Controversy ◽  
Emergency Department Patients ◽  
Patient Subgroups ◽  
Target Glucose

ABSTRACTObjectives:To clarify the benefits, risks and timing of glucose control and intensive insulin therapy in several groups, specifically the neurologic, cardiac and septic populations of patients, commonly seen in the emergency department.Methods:Electronic search of MEDLINE (1966–2005; once with PubMed and once with Ovid) and Embase (1980–2005) using the terms insulin and glucose combined with emergency medicine, intensive care, cardiology and emergency department.Results:There is considerable controversy in the literature surrounding the use of strict glucose control in cardiac, neurologic and septic patients. Much of this literature is non-randomized, and the timing of therapy is poorly investigated.Conclusions:Hyperglycemia is associated with adverse outcomes in acutely ill neurologic, cardiac and septic patients, but it remains unclear whether this is a causative association. Glucose control and intensive insulin therapy may be useful in some patient subgroups; however, controlled trials of aggressive glycemic control have provided insufficient evidence to justify subjecting patients to the real risks of iatrogenic hypoglycemia. We recommend a cautious approach to the control of glucose levels in acutely ill emergency department patients, with a target glucose of below 8 to 9 mmol/L.

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