gms | German Medical Science

To compare the influence of intensified insulin therapy on mortality, long-term functional outcome and quality of life compared to a standard treatment regimen.

In a prospective study patients with CNS injury (subarachnoid hemorrhage, traumatic brain injury, intracerebral bleeding) requiring mechanical ventilatory support for at least 24h were randomised either to the intensified insulin therapy (glucose 80-120 mg/dl) or a standard treatment regimen (180-220 mg/dl). Outcome at discharge from intensive care unit and after 3 months was assessed using the Glasgow outcome score (GOS), long-term outcome after 6 months was obtained by personal examination and interviews using the GOS and the SF-36 test (self and proxy-rating).

So far 108 patients were included in the study. 52 patients (mean age 59.3±15.6) were randomised to the standard group (STD), 56 patients (mean age 56.9±14.8) to the intensified group (INT). Initial median GCS on scene was 10 in both groups and 3 on admittance to the intensive care unit. Mean blood glucose level during the stay on the intensive care unit was 153±30 mg/dl in the STD and 116±29 mg/dl in the INT (p<0.01). Median GOS at discharge was 3 in both groups. Median long-term follow-up time was 27 weeks in the ITN and 24 weeks in the STD. At the time of last follow-up a total of 36 patients had died, 18 in each group, respectively. Median GOS after 6 months of the surviving patients was 4 in both groups. There were no differences between the physical (STD:41±10, INT: 36±10) and psychological scores (STD:46±11, INT:45±15) in both groups (self-rating). A comparison between self-rating and proxy-rating evaluation yielded comparable results.

Our preliminary data show that the patients involved in the study achieve a considerable degree of quality of life. Furthermore a good correlation between self and proxy rating could be shown. However, it seems that intensified insulin therapy may not have a significant effect on short and long-term outcome.