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To the Editor: Dr Finney and colleagues¹ concluded that "increased insulin administration is positively associated with death in the ICU [intensive care unit] regardless of the prevailing blood glucose level. Thus, control of glucose levels rather than of absolute levels of exogenous insulin appear to account for the mortality benefits associated with intensive insulin therapy demonstrated by others." It is unclear, however, whether these conclusions apply equally to patients who are admitted to the ICU for medical vs surgical diagnoses.

Patients with "medical admissions" comprised only 11.7% of the total number of patients in this study, but accounted for 56% of the total mortality. Furthermore, the length of stay in the ICU was far greater for patients with "medical admissions" (7.7 days vs 1 day for patients who had undergone coronary artery surgery).

The authors may be correct that intensive glucose control improves mortality in critically ill surgical patients (especially . . . [Full Text of this Article]

Reuven Moshenyat, MD; Yizhak Y. Kupfer, MD; Sidney Tessler, MD
stessler@maimonidesmed.org
Maimonides Medical Center
Brooklyn, NY

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