Insulintherapie auf der Intensivstation

Hyperglycemia in patients treated in intensive care units (ICU) with and without known diabetes mellitus is associated with increased mortality and morbidity. Until 2007 the limited evidence from controlled studies and guidelines recommended the following: start insulin treatment when plasma glucose levels are higher than 110?C140?mg/dl (6.1?C7.8?mmol/l) targeting plasma glucose levels of 80?C110?mg/dl (4.4?C6.1?mmol/l). Larger studies and meta-analyses from 2008 onwards showed completely different results. The aggressive insulin treatment showed no beneficial effects on mortality and the largest study (NICE-SUGAR, CMAJ 2009, 180:821?C827) even showed an increased mortality rate compared to moderately treated controls. The morbidity in consideration of severe hypoglycemia was increased in all studies. Therefore scientific societies changed their guidelines from 2009 recommending insulin treatment when plasma glucose levels are higher than 180?mg/dl (10?mmol/l) and targeting plasma glucose levels of 140?C180?mg/dl (7.8?C10?mmol/l). As the prevention of severe hypoglycemia is extremely important only safe insulin protocols should be used. The Yale protocol is one of the safest insulin algorithms and will be presented here in detail.