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In Reply: In response to Drs Van den Berghe and Bouillon, we indicated that APACHE II scores, SOFA scores, and reason for admission were all included in the logistic regression analysis. Age was removed as it did not improve the model fit, possibly because it is already contained within the APACHE II instrument. Consequently, we believe our model did examine the relationship between insulin administration, glycemia, and mortality, and was not confounded by severity of illness. Furthermore, because the predicted odds ratios of death attributable to insulin administration were the same in each glycemic band examined, it is highly unlikely that our results simply reflect insulin resistance.

Second, we do not dispute that insulin administered with the aim of lowering blood glucose levels reduces mortality, as reported by Van den Berghe et al.¹ Rather, we propose that although insulin may itself be harmful, in high glycemic bands its administration obviates . . . [Full Text of this Article]

Simon J. Finney, MBChB, MRCP; Timothy W. Evans, MD, DSc, FRCP
t.evans@rbh.nthames.nhs.uk
Adult Intensive Care Unit
Royal Brompton Hospital
London, England

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