Insulin spares intensive care patients from organ failure and death
It was previously shown, in a large, randomized, controlled trial that controlling blood glucose with insulin reduces the risk of organ failure and death of patients in intensive care. But the underlying mechanisms explaining these clinical benefits remained incompletely understood.
In a new study appearing on August 1 in The Journal of Clinical Investigation, the same group, Greet Van den Berghe and colleagues from Katholieke Universitiet Leuven, show that there is disturbed microcirculation in these patients that is due to endothelial dysfunction which causes inadequate oxygen supply to the cellular systems. The endothelium controls vascular flow and trafficking of important biological molecules. The endothelium of patients with prolonged critical illness is protected by strict blood glucose control with insulin and this may play a major role in the prevention of organ failure and death with this treatment.
This data may open perspectives for novel treatments and for progress in intensive care medicine. In an accompanying commentary, Dandona, et al write, "the results suggest a new paradigm in which glucose and insulin are related not only through their metabolic actions but also through their opposite effects on inflammatory mechanisms."
TITLE: Intensive insulin therapy protects the endothelium of critically ill patients
AUTHOR CONTACT:
Greet Van den Berghe
Katholieke Universiteit Leuven, Leuven, Belgium
Phone: +32 16 344021; Fax: 32 16 3440 15; E-mail: greta.vandenberghe@med.kuleuven.ac.be
View the PDF of this article at: https://www.the-jci.org/article.php?id=25385
ACCOMPANYING COMMENTARY:
TITLE: Insulin infusion in acute illness
AUTHOR CONTACT:
Paresh Dandona
SUNY Buffalo, Buffalo, NY USA
Phone: 716 887 4523; Fax: 716 887 4773; E-mail: pdandona@kaleidahealth.org
View the PDF of this article at: https://www.the-jci.org/article.php?id=26045
Journal
Journal of Clinical Investigation