Intensive Insulin Therapy in Severely Burned Pediatric Patients: A Prospective Randomized Trial

Rationale: Hyperglycemia and insulin resistance have been shown to increase morbidity and mortality in severely burned patients, and glycemic control appears essential to improve clinical outcomes. However, to date no prospective randomized study exists that determines whether intensive insulin therapy is associated with improved post-burn morbidity and mortality. Objectives: To determine whether intensive insulin therapy is associated with improved post-burn morbidity. Methods:Atotalof239severelyburnedpediatricpatientswithburns over greater than 30% of their total body surface area were randomized (block randomization 1:3) to intensive insulin treatment (n 5 60) or control (n 5 179). Measurements and Main Results: Demographics, clinical outcomes, sepsis,glucosemetabolism,organfunction,andinflammatory,acutephase, and hypermetabolic responses were determined. Demographics were similar in both groups. Intensive insulin treatment significantly decreased the incidence of infections and sepsis comparedwithcontrols(P ,0.05).Furthermore,intensiveinsulintherapy improved organ function as indicated by improved serum markers, DENVER2scores,andultrasound(P ,0.05). Intensiveinsulintherapy alleviatedpost-burninsulinresistanceandthevastcatabolicresponse ofthebody(P ,0.05).Intensiveinsulintreatmentdampenedinflammatoryandacute-phaseresponsesbydeceasingIL-6andacute-phase proteins compared with controls (P , 0.05). Mortality was 4% in the intensive insulin therapy group and 11% in the control group (P 5 0.14). Conclusions: In this prospective randomized clinical trial, we showed that intensive insulin therapy improves post-burn morbidity. Clinical trial registered with www.clinicaltrials.gov (NCT00673309).