Comparison of metformin and insulin in the control of hyperglycaemia in
non-diabetic critically ill patients.
Author(s): Mojtahedzadeh M, Jafarieh A, Najafi A, Khajavi MR, Khalili N.
Affiliation(s): Faculty of Pharmacy and Pharmaceutical Sciences Research Centre, Teheran
University of Medical Sciences, Teheran, Iran.
Publication date & source: 2012, Endokrynol Pol. , 63(3):206-11
INTRODUCTION: It is accepted that preventing hyperglycaemia during critical
illness while assuring adequate caloric intake can reduce mortality and
morbidity. The aim of this study was to compare the metabolic effects of
metformin and insulin on hyperglycaemia in ICU patients.
METHODS: This double-blind randomised clinical trial was performed on 24 patients
who were admitted to the intensive care unit (ICU) from 20 March to 20 September
2007. All patients with serious injuries or with major non-abdominal surgeries
were included if they met the inclusion criteria, and were assigned randomly to
one of the study groups. Patients in Group 1 received intensive insulin therapy,
and patients in Group 2 were treated with metformin. Moreover, the Acute
Physiology And Chronic Health Evaluation (APACHE) II scoring system was used to
grade disease severity.
RESULTS: Both glycaemic management protocols led to significantly improved
glucose levels without any report of hypoglycaemia. The mean initial glucose
levels for the insulin group decreased significantly after the intravenous
infusion of insulin (p < 0.001). Additionally, the blood glucose concentration
was significantly lower after two weeks of metformin administration compared to
baseline measurements (p < 0.001). Moreover, the blood glucose concentration
decrease during these two weeks was significantly higher in the insulin group (p
= 0.01). Besides, APACHE II score was lower than baseline at the end of the study
for both therapeutic groups (score of 10 vs. 15 [insulin] and 16 [metformin]).
Finally, new renal dysfunction (maximum serum creatinine level at least double
the initial value) was observed in three of the patients (two patients from the
metformin group and one from the insulin group) in the last days of the protocol,
although none of the patients showed lactic acidosis after ICU admission.
CONCLUSIONS: Both metformin and intensive insulin therapy significantly decreased
hyperglycaemia in ICU patients. Insulin caused a greater reduction in blood
glucose concentration but required more attention and trained personnel.
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