DIABETES/METABOLISM RESEARCH AND REVIEWS REVIEW ARTICLE Diabetes Metab Res Rev 2007; 23: 184–192. Published online 6 November 2006 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/dmrr.696 Insulin-based regimens decrease mortality rates in critically ill patients: A systematic review Jane Langley 1 Gary Adams 2 * 1 Intensive Care, Lincoln County Hospital, Greetwell Road, Lincoln, Lincolnshire, LN2 5QY, UK 2 Insulin Diabetes Experimental Research Group, Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, NG7 2UH, United Kingdom *Correspondence to: Gary Adams, Insulin Diabetes Experimental Research Group, Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, NG7 2UH, United Kingdom. E-mail: Gary.Adams@nottingham.ac.uk Received: 25 April 2006 Revised: 12 September 2006 Accepted: 19 September 2006 Summary Objectives To determine whether treatment with glucose-insulin-potassium (GIK), insulin and glucose, or insulin by itself is beneficial in limiting organ damage after acute myocardial infarction (AMI) and reducing mortality and morbidity among critically ill hyperglycaemic patients. Methods Systematic review of randomized controlled trials. Main outcome measure To assess whether tight glycaemic control reduces morbidity and mortality. Studies reviewed Randomized controlled trials of insulin-based regimens in the treatment of critically ill patients. Results Nine hundred and twenty-four potentially relevant studies were identified and screened for retrieval. Of these, 16 randomized controlled trials met the inclusion criteria (Table 1). Ten studies examined the effects of GIK, and six of these studies reported a mortality reduction with GIK treatment in addition to enhanced myocardial performance. Five studies examined the administration of insulin. Among these studies, tight glycaemic control of blood glucose in one study was shown to reduce morbidity and mortality of patients in intensive care. Only one study examined insulin/glucose therapy, and it showed a post-myocardial infarction mortality reduction of one year. Conclusions There is increasing evidence that maintaining normoglycaemia and treatment with insulin-based regimens is beneficial in limiting organ damage and significantly reduces both morbidity and mortality in critically ill patients who require intensive care therapy. Copyright  2007 John Wiley & Sons, Ltd. Keywords Glycaemic; regimens; critically Ill; mortality rates Introduction The evolution of intensive care medicine in the past 30 to 40 years has fostered a tremendous increase in the immediate survival of patients suffering from acute, previously lethal, physiological insults [1]. Hence, patients now frequently enter a chronic phase of critical illness during which they remain dependent on vital organ support for a more or less extended period. Among these prolonged critically ill patients, mortality has remained high, with a 20% risk of death, on average, mostly from non-resolving multiple organ failure and regardless of whether the initial disease required admission to Copyright  2007 John Wiley & Sons, Ltd.