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Intensive Insulin Therapy
Neil Orford on 03-02-2011
Anthony Tzannes comments regarding IIT
A few comments from my reading of the study:
1. A concern with the protocol of the study: namely that if hypoglycaemia was found on testing BSL, then it would not be treated until formal blood result back confirming the result - resulting in potentially long periods of hypoglycaemia (I may have misinterpreted this, as it seems illogical unless greater concern was made for high BSL than low as part of study design)
2. Tight control group had an average BSL of 6.8 and thus either had periods of very high BSL or (more likely) had majority of time with BSL outside target range.
My interpretation of the the second point is that the study failed to achieve its target an thus it cannot be stated that more relaxed BSL control is better for critically ill patients than tight control. What can be stated is that with current technology, attempting to achieve tight control in the critically ill patients results in overall worse outcomes (taking into account point 1 above)
A subgroup analysis of those patients that did achieve tight control without any hypoglycaemic events would be interesting (or may just muddy the waters further!)
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