Intensive Insulin Therapy Useful Following Brain Surgery

Intensive insulin therapy in patients after brain surgery is associated with iatrogenic hypoglycemia, but it can also reduce the infection rate and shorten intensive care unit (ICU) stay, according to a new study.

Researchers at the University of Rome La Sapienza (Italy) conducted a prospective randomized controlled trial of 483 patients undergoing elective or emergency brain surgery. The patients were prospectively and randomly assigned either to intensive insulin therapy (241 patients), receiving insulin titrated to maintain blood glucose levels within the range of 4.44-6.11 mM (mmol/L), or to conventional insulin therapy (242 patients), with patients receiving insulin to maintain blood glucose levels below 11.94 mM. The primary endpoint was incidence of hypoglycemia (defined as blood glucose levels lower than 2.78 mM). Efficacy measures included the length of ICU stay, infection rate, and 6 months follow-up Glasgow outcome scale score and overall survival.

The researchers found that median number of hypoglycemic episodes in the intensive insulin therapy group was eight, significantly higher than the three episodes observed in the conventional insulin therapy group. The only factor independently related to severe hypoglycemia was intensive insulin therapy. The researchers also noted that the median length of stay in the ICU was shorter and the infection rate was lower in patients who received intensive insulin therapy than in patients who received conventional insulin therapy. Overall survival at 6 months did not differ significantly between the two treatment groups.

"Although intensive insulin therapy has benefits, given the high rate of severe hypoglycemia in these patients, intensive insulin therapy that attempts to set blood glucose levels within the range of 4.44-6.11 mM may raise safety concerns," concluded lead author Federico Bilotta, M.D.,

The researchers therefore recommended that a wider range of blood glucose levels be tested for safety and efficacy and strongly suggest keeping glycemia below 150 mg/dL in neurosurgical patients receiving postoperative intensive care.

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