Effect of Early vs Delayed or No Insulin Therapy for Moderate Hyperglycemia in Patients in the ICU: A Target Trial Emulation
Authors' conclusion
In this target trial emulation, early insulin treatment of moderate hyperglycemia showed reduced mortality in acutely admitted adult patients in the ICU, particularly when insulin was initiated within 2 hours following hyperglycemia.
Study context
- Population
- Acutely admitted adult ICU patients with moderate hyperglycemia (10–13.9 mM), 4 ICUs at Karolinska University Hospitals, 2010 to 2021
- Participants
- 5,755 participants
- Comparison
- Early insulin vs delayed or no insulin
- Early insulinn = 3,149
- Delayed or no insulinn = 2,606reference
- Outcome
- All-cause mortality
- Follow-up
- 30 days
Methodological detailsmulticentre, targeted minimum loss-based estimation
- Multicentre
- Targeted minimum loss-based estimation
Main finding
Adjusted 30-day mortality
Absolute risk reduction
2.3 %
95% CI 1.1–3.6
By group
As reported in the abstract
Further findings
| Outcome | Absolute risk reduction (percentage points) (95% CI) |
|---|---|
| 30-day mortality, insulin within 1 hour of first moderate hyperglycemia | 7.7 (6.5–8.9) |
| 30-day mortality, insulin within 2 hours | 6.6 (5.4–7.8) |
Subgroups (subgroup)
- Effect modified in several subgroups
Original publication
Effect of Early vs Delayed or No Insulin Therapy for Moderate Hyperglycemia in Patients in the ICU: A Target Trial Emulation. Chest. Published 16 August 2026. doi:10.
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