TABLE 2

Insulin therapy, nutrition, blood glucose control, and hypoglycemia

Intention to treat (n = 2,748)
In ICU at least 3 days (n = 1,389)
In ICU <3 days (n = 1,359)
ConventionalIntensiveP valueConventionalIntensiveP valueConventionalIntensiveP value
n1,3881,360702687686673
Total amount of feeding (kcal · kg−1 · day−1)15 ± 815 ± 80.220 ± 619 ± 70.0610 ± 510 ± 50.7
    Amount of parenteral calories (kcal · kg−1 · day−1)*13 ± 713 ± 70.716 ± 716 ± 7>0.910 ± 510 ± 50.7
    Amount of enteral calories (kcal · kg−1 · day−1)2.3 ± 0.11.9 ± 0.10.14.2 ± 0.23.5 ± 0.20.080.4 ± 0.070.2 ± 0.040.4
    Number of patients receiving predominantly parenteral calories1,166 (85)1,175 (87)0.2525 (75)531 (77)0.3641 (96)644 (97)0.3
    Average daily amount of intravenous glucose (g/day)*160 ± 66161 ± 640.8179 ± 65179 ± 64>0.9141 ± 62143 ± 600.6
    Number of patients receiving at least some enteral nutrition555 (40)511 (38)0.2468 (67)443 (64)0.487 (13)68 (10)0.1
Daily insulin dose (IU/day)1 (0–24)59 (37–84)<0.00017 (0–36)68 (47–96)<0.00010 (0–12)48 (30–73)<0.0001
Mean blood glucose level (mg/dl)152 ± 32105 ± 24<0.0001152 ± 27103 ± 21§<0.0001151 ± 35107 ± 27§<0.0001
    In lowest tertile of intravenous glucose149 ± 37107 ± 26<0.0001147 ± 28103 ± 14150 ± 41109 ± 31<0.0001
    In middle tertile of intravenous glucose151 ± 30105 ± 22<0.0001152 ± 27105 ± 19<0.0001151 ± 32104 ± 32<0.0001
    In highest tertile of intravenous glucose154 ± 28104 ± 24<0.0001155 ± 27103 ± 24<0.0001153 ± 29105 ± 22<0.0001
Patients per strata of blood glucose control<0.0001<0.0001<0.0001
    >150 mg/dl656 (47.5)41 (3.0)353 (50.3)10 (1.5)303 (44.5)31 (4.6)
    110–150 mg/dl639 (46.2)374 (27.7)322 (45.9)160 (23.4)317 (46.6)214 (32.1)
    <110 mg/dl87 (6.3)935 (69.3)27 (3.8)514 (75.1)#60 (8.8)421 (63.2)#
Hypoglycemia25 (1.8)154 (11.3)<0.000120 (2.8)130 (18.9)<0.00015 (0.7)24 (3.6)0.0003
More than one hypoglycemic event5 (0.4)31 (2.3)<0.00013 (0.4)30 (4.4)<0.00012 (0.3)1 (0.2)0.6
Level of blood glucose during hypoglycemia (mg/dl)32 ± 733 ± 50.732 ± 733 ± 50.732 ± 832 ± 6>0.99
Hypoglycmia without insulin6 (0.4)5 (0.4)0.85 (0.7)4 (0.6)0.81 (0.1)1 (0.1)1.0
Mean daily amount of kilocal administered to patients with hypoglycemia (kcal · kg−1 · day−1)20 ± 720 ± 7>0.923 ± 522 ± 60.49 ± 511 ± 50.5
Mean daily amount of kilocal administered to patients without hypoglycemia (kcal · kg−1 · day−1)15 ± 814 ± 70.000220 ± 619 ± 70.000210 ± 510 ± 50.5
Among patients with hypoglycemia (n)2515420130524
    Immediate (8 h) symptoms3 (12.0)6 (3.9)0.12 (10.0)5 (3.8)0.31 (20.0)1 (4.2)0.4
    Death within 24 h of hypoglycemia3 (12.0)1 (0.6)0.00043 (15.0)0 (0.0)<0.00010 (0.0)1 (4.2)0.6
    Hospital mortality13 (52.0)78 (50.6)0.913 (65.0)71 (54.6)0.40 (0.0)7 (29.2)0.2
    Late neurological sequellae (survivors)0 (0.0)3 (3.9)**0.50 (0.0)3 (5.1)**0.50 (0.0)0 (0.0)1.0
  • Data are n (%), means ± SD, or median (interquartile range) unless otherwise indicated.

  • *

    * All intravenous calories were counted, including those for nonnutritional purposes such as solutes for intravenous drugs and bolus injections for correction of hypoglycemia.

  • Non–normally distributed data are represented as means ± SE; P values calculated by Mann-Whitney-U test.

  • Less than one-third of administered calories via the enteral route.

  • §

    § P = 0.02 for the difference between blood glucose control between IIT groups treated at least 3 days and those treated <3 days.

  • P < 0.05 and

  • P < 0.01 for comparison between the two marked tertiles among one randomization goup.

  • #

    # P < 0.0001 for the difference in distribution of patients in the different strata of blood glucose control among short-stay patients compared with long-stay patients.

  • **

    ** Suffering from coma or epilepsy prior to hypoglycemia.