Critically ill babies and children commonly develop abnormally high blood sugar (hyperglycaemia). Hyperglycaemia is linked to mortality and secondary infections. An article in The Lancet explains that intensive insulin therapy reduces these children's blood sugar to normal levels, thus lowering mortality and infection rates, as well as shortening their intensive care stay.

The article was Professor Greet Van den Berghe, University Hospital, Gasthuisberg and Catholic University Leuven, Belgium and colleagues.

The authors explain that before this study was carried out, we did not know what effect the lowering of blood glucose levels in these hyperglycaemic children to age-adjusted normal ranges might have. The randomized controlled study looked at 700 critically ill patients, 317 of them were less than one year old, while 282 were aged from 1 year to 16 years. 349 were randomly assigned to receive intensive insulin treatment to reduce their blood glucose level to what it should be for their age, while 351 patients received insulin treatment only if their hyperglycaemia reached critically high levels. The second group is known as the conventional group in this study.

The scientists found that mean blood glucose concentrations were significantly lower in the intensive group than in the conventional group. A higher number of patients in the intensive group experienced hypoglycaemia, i.e. their blood sugar levels dropped to abnormally low levels. In spite of this, mortality was lower in the intensive group (3%) compared to the conventional group (6%). The researchers also reported that the intensive care was shorted for the intensive group, whose stay average 5.5 days, compares to the conventional group (6.1 days).

"Targeting of blood glucose concentrations to age-adjusted normal fasting concentrations improved short-term outcome of patients in paediatric intensive care units. The effect on long-term survival, morbidity, and neurocognitive development needs to be investigated," the authors concluded.

"Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study."
Dirk Vlasselaers MD, Ilse Milants RN, Lars Desmet MD, Pieter J Wouters MSc, Ilse Vanhorebeek PhD, Ingeborg van den Heuvel MD, Dieter Mesotten MD, Michael P Casaer MD, Geert Meyfroidt MD, Catherine Ingels MD, Jan Muller MD, Sophie Van Cromphaut MD, Miet Schetz MD, Prof Greet Van den Berghe MD
The Lancet, Early Online Publication, 27 January 2009 doi:10.1016/S0140-6736(09)60044-1
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