Management of critically ill patients with type 2 diabetes: The need for personalised therapy

Table 5 Interventional studies (diabetes as a binary variable) and outcomes related to hyperglycaemia (chronological order)

Ref.	Year	Study pts	Study point	Non diabetic patients	Diabetic patients	Overall message
1Van den Berghe et al[54]	2006	2748	ITT (blood glucose 4.4-6.1 mmol/L) vs CIT (insulin if blood glucose > 12 then target 10-11.1 mmol/L) on mortality	Reduced mortality and morbidity with ITT	No survival benefit with ITTHigher rates of hypoglycaemia	Hosp mortality 20% (40/200) of the DM patients in conventional arm Hosp mortality 22% (46/207) of the DM patients in the ITT arm
Arabi et al[39]	2008	523	ITT (blood glucose 4.4-6.1 mmol/L) vs CIT (blood glucose 10-11.1 mmol/L) on ICU mortality	Mortality: ITT (14%) vs CIT (14%) - no significant difference (P = 0.2)	Mortality: ITT (13%) vs CIT (20%) - no significant difference (P = 0.3)	No significant difference in ICU mortality between IIT and CIT (P = 0.3)
Brunkhorst et al[38]	2008	537	ITT (blood glucose 4.4-6.1 mmol/L) vs CIT (blood glucose 10-11.1 mmol/L) on mortality	28 d mortality: ITT 25% vs CIT 23% (P = 0.8)90 d mortality: ITT 40% vs CIT 32% (P = 0.2)	28 d mortality: ITT 25% vs CIT 32% (P = 0.3)90 d mortality: ITT 40% vs CIT 42% (P = 0.9)	No mortality benefit with ITT vs CITStopped early due to safety risk
Del La Rosa et al[42]	2008	504	ITT (blood glucose 4.4-6.1 mmol/L) vs CIT (blood glucose 10-11.1 mmol/L) on morbidity and mortality	ICU mortality ITT 37% vs CIT 32% (no significance)2In-hospital mortality: ITT 40% vs CIT 39% (no significance)2	Mortality: ITT (38%) vs CIT (31%) - no significant difference	No difference in ICU mortality, 28 d mortality or ICU infectionsIncreased hypoglycaemia in ITT
Finfer et al[41]	2009	6029	ITT (blood glucose 4.4-6.1 mmol/L) vs CIT (blood glucose < 10 mmol/L) on mortality	Mortality: ITT (27%) vs CIT (24%) - no significant difference	Mortality: ITT (32%) vs CIT (28%) - no significant difference	ITT arm - inc 90 d mortalityNo difference in those with and without DM (P = 0.60)
Preiser et al[40]	2009	1078	ITT (blood glucose 4.4-6.1 mmol/L) vs CIT (blood glucose 7.8-10 mmol/L) on mortality	ICU mortality ITT 17% vs CIT 15% (P = 0.4) 2Hospital mortality: ITT 23% vs CIT 19% (P = 0.1)2	Not described	Stopped early due to protocol violations

¹Contains pooled data from the 2001 (surgical) and 2006 (medical) study;

²Mortality of total patients (includes non-diabetic and diabetic patients). ITT: Intensive insulin therapy; CIT: Conventional insulin therapy; Inc: Increased; Dec: Decrease.