Editor Choice: Tight Glycemic Control Reduces Infection

Background: Tight glycemic control (TGC) may improve outcomes in hyperglycemic neurosurgical patients. The adoption of TGC has been limited by a lack of adequate data on optimal insulin delivery protocols and serum glucose concentration and by concerns about the risks of hypoglycemia.

Objective: This study was designed as a meta-analysis of outcomes to compare intensive insulin therapy and TGC with conventional insulin therapy and conventional glucose control. The secondary objective was to determine retrospectively whether a particular glucose range correlates with better outcomes.

Methods: Using electronic databases, we retrieved all English language studies published between January 1997 and December 2010 reporting outcomes in neurological and neurosurgical patients as a function of glucose levels and insulin protocols. We conducted a meta-analysis around 4 outcome measures: infection, neurological outcome, hypoglycemia, and mortality. Effect sizes in each study were individually correlated with target intensive insulin therapy glucose levels. Individual studies were assessed for quality by use of the Jadad scale.

Ahead of Print: Tight Glycemic Control Reduces Infection

Background: Tight glycemic control (TGC) may improve outcomes in hyperglycemic neurosurgical patients. The adoption of TGC has been limited by lack of adequate data regarding optimal insulin delivery protocols and serum glucose concentration, and concerns regarding the risks of hypoglycemia.

Objective: This study was designed as a meta-analysis of outcomes to compare IIT (Intensive Insulin Therapy) and TGC with CIT (Conventional Insulin Therapy) and CGC (Conventional Glucose Control). The secondary objective was to determine retrospectively whether a particular glucose range correlates with better outcomes.

Methods: Using electronic databases, we retrieved all English language studies published between January 1997 and December 2010 reporting outcomes in neurological and neurosurgical patients as a function of glucose levels and insulin protocols. We conducted a meta-analysis around four outcome measures: infection, neurological outcome, hypoglycemia, and mortality. Effect sizes in each study were individually correlated with target IIT glucose levels. Individual studies were assessed for quality using the Jadad scale.