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To the Editor: Based on their observational study, Dr Finney and colleagues¹ speculated that less-stringent control of blood glucose levels suffices to optimize survival among critically ill patients, and that infusing more insulin may actually be harmful. In contrast, our randomized, controlled, intervention study found that intensive insulin therapy to maintain blood glucose levels below 110 mg/dL reduced mortality among critically ill patients.²

We are concerned that the data of Finney et al do not support their speculations. The authors analyzed the relationship between mortality, the time a patient spent in different strata of blood glucose levels, and the amount of insulin infused in each stratum. The logistic regression model, which did not include age, Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores, or Sequential Organ failure Assessment (SOFA) scores, and thus did not correct for these known risk factors, revealed that more infused insulin was associated with increased . . . [Full Text of this Article]

Greet Van den Berghe, MD, PhD
greta.vandenberghe@med.kuleuven.ac.be
Department of Intensive Care Medicine

Roger Bouillon, MD, PhD
Laboratory for Experimental Medicine and Endocrinology
Catholic University of Leuven
Leuven, Belgium

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