| Hyperglycemia is a prevalent scenario in critically ill patients. Hyperglycemia is associated with many adverse outcomes, including immune disorder, oxidative stress, susceptibility to infection, and endothelial dysfunction. Its impact is believed to be independently associated with increased mortality because it enhances the inflammatory responses. Some randomized controlled clinical trials have attempted to determine whether intensive insulin therapy targeted on establishing normoglycemia could benefit septic patients. Initial studies of adjustable insulin infusions to decrease blood glucose levels raised interest in inpatient glycemic control strategies (1,2), and several organizations called for implementing intensive insulin therapy (IIT) strategies using adjustable insulin infusions titrated to strict glycemic targets in the intensive care unit. Despite the early evidence of benefit from IIT (3-6), many subsequent trials, including the largest IIT trial to date, have not found a consistent benefit (7). |