Influence and mechanism of a tight control of blood glucose by intensive insulin therapy on human sepsis

Objective To investigate the effect of a tight control of blood glucose by intensive insulin therapy on human sepsis, and to explore the potential mechanism of the intensive insulin therapy. Methods Eligible patients were randomized by a blinded pharmacist to receive tight control of blood glucose by intensive insulin therapy (maintenance of blood glucose at a level between 4 4 and 6 1 mmol/L) or to receive conventional treatment (maintenance of glucose at a level between 10 0 and 11 1 mmol/L). The expression of HLA DR on peripheral monocytes was measured in 54 patients by flow cytometry on 24 h、3 d、5 d、7 d、10 d and 14 d of intensive care in parallel with serum c reactive protein (CRP), severity of the disease (APACHE II score, SOFA score) and clinical data collection. Results Patients receiving intensive insulin therapy were less likely to require prolonged mechanical ventilation. Tight control of blood glucose significantly reduced the number of days during which leukopenia or leukocytosis and the days with hypo or hyperthermia ( P 0 05). Hypoglycemia occurred in 3 patients (10 7%) in the tight control of blood glucose group. There were no instance of hemodynamic deterioration or convulsions. Compared with the conventional treatment, tight control of blood glucose also increased the HLA DR expression of peripheral monocytes, and there were significantly difference on 3 d, 5 d and 7 d ( P 0 05). Whereas it suppressed the elevated serum CRP concentrations, there was significantly difference on 7 d ( P 0 05). Conclusions Tight control of blood glucose by intensive insulin therapy expedited healing of human sepsis, and increased the HLA DR expression of peripheral and suppressed the elevated serum CRP. So, it is necessary to use insulin to strict control the glucose levels in human sepsis.