Anesthesiology and Pain Medicine

Published by: Kowsar

Predisposing Factors for Hypoglycemia and Its Relation With Mortality in Critically Ill Patients Undergoing Insulin Therapy in an Intensive Care Unit

Ata Mahmoodpoor 1 , Hadi Hamishehkar 2 , Mahammadtaghi Beigmohammadi 3 , Sarvin Sanaie 4 , Kamran Shadvar 3 , Hassan Soleimanpour 5 , * , Ahsan Rahimi 6 and Saeid Safari 7
Authors Information
1 Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2 Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
3 Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
4 Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
5 Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
6 Students Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
7 Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
Article information
  • Anesthesiology and Pain Medicine: February 01, 2016, 6 (1); e33849
  • Published Online: January 31, 2016
  • Article Type: Research Article
  • Received: October 17, 2015
  • Revised: November 22, 2015
  • Accepted: November 29, 2015
  • DOI: 10.5812/aapm.33849

To Cite: Mahmoodpoor A, Hamishehkar H, Beigmohammadi M, Sanaie S, Shadvar K, et al. Predisposing Factors for Hypoglycemia and Its Relation With Mortality in Critically Ill Patients Undergoing Insulin Therapy in an Intensive Care Unit, Anesth Pain Med. 2016 ; 6(1):e33849. doi: 10.5812/aapm.33849.

Copyright © 2016, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Patients and Methods
4. Results
5. Discussion
  • 1. Sung J, Bochicchio GV, Joshi M, Bochicchio K, Tracy K, Scalea TM. Admission hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma. 2005; 59(1): 80-3[PubMed]
  • 2. Parish M, Mahmoodpoor A, Sanaie S. Validity of fasting blood sugar on day of surgery compared with the preinduction blood glucose level in Type II diabetic patients. Pak J Med Sci. 2007; 23(2): 202
  • 3. Gale SC, Sicoutris C, Reilly PM, Schwab CW, Gracias VH. Poor glycemic control is associated with increased mortality in critically ill trauma patients. Am Surg. 2007; 73(5): 454-60[PubMed]
  • 4. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013; 39(2): 165-228[DOI][PubMed]
  • 5. Mahmoodpoor A, Ali-Asgharzadeh A, Parish M, Amiraslanzadeh Z, Abedini N. A comparative study of intensive insulin therapy versus conventional method on mortality and morbidity of critically ill patients. Pak J Med Sci. 2011; 27: 496-9
  • 6. Safari S, Rahmani F, Soleimanpour H, Ebrahimi Bakhtavar H, Mehdizadeh Esfanjani R. Can APACHE II Score Predict Diabetic Ketoacidosis in Hyperglycemic Patients Presenting to Emergency Department? Anesth Pain Med. 2014; 4(4)[DOI][PubMed]
  • 7. Soleimanpour H, Rahmani F, Safari S, Golzari SE. Hypothermia after cardiac arrest as a novel approach to increase survival in cardiopulmonary cerebral resuscitation: a review. Iran Red Crescent Med J. 2014; 16(7)[DOI][PubMed]
  • 8. Soleimanpour H, Rahmani F, Golzari SE, Safari S. Main complications of mild induced hypothermia after cardiac arrest: a review article. J Cardiovasc Thorac Res. 2014; 6(1): 1-8[DOI][PubMed]
  • 9. Soleimanpour H, Taghizadieh A, Niafar M, Rahmani F, Golzari SE, Esfanjani RM. Predictive value of capnography for suspected diabetic ketoacidosis in the emergency department. West J Emerg Med. 2013; 14(6): 590-4[DOI][PubMed]
  • 10. Krinsley JS, Grover A. Severe hypoglycemia in critically ill patients: risk factors and outcomes. Crit Care Med. 2007; 35(10): 2262-7[DOI][PubMed]
  • 11. Bagshaw SM, Bellomo R, Jacka MJ, Egi M, Hart GK, George C, et al. The impact of early hypoglycemia and blood glucose variability on outcome in critical illness. Crit Care. 2009; 13(3)[DOI][PubMed]
  • 12. Cook CB, Potter DJ, Kongable GL. Characterizing glucose changes antecedent to hypoglycemic events in the intensive care unit. Endocr Pract. 2012; 18(3): 317-24[DOI][PubMed]
  • 13. Cryer PE. Hypoglycaemia: the limiting factor in the glycaemic management of the critically ill? Diabetologia. 2006; 49(8): 1722-5[DOI][PubMed]
  • 14. Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008; 358(2): 125-39[DOI][PubMed]
  • 15. Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006; 354(5): 449-61[DOI][PubMed]
  • 16. Kosiborod M, Inzucchi SE, Goyal A, Krumholz HM, Masoudi FA, Xiao L, et al. Relationship between spontaneous and iatrogenic hypoglycemia and mortality in patients hospitalized with acute myocardial infarction. JAMA. 2009; 301(15): 1556-64[DOI][PubMed]
  • 17. Vriesendorp TM, van Santen S, DeVries JH, de Jonge E, Rosendaal FR, Schultz MJ, et al. Predisposing factors for hypoglycemia in the intensive care unit. Crit Care Med. 2006; 34(1): 96-101[PubMed]
  • 18. Vriesendorp TM, DeVries JH, van Santen S, Moeniralam HS, de Jonge E, Roos YB, et al. Evaluation of short-term consequences of hypoglycemia in an intensive care unit. Crit Care Med. 2006; 34(11): 2714-8[DOI][PubMed]
  • 19. Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Eng J Med. 2001; 345(19): 1359-67
  • 20. Najafi A, Mojtahedzadeh M, Mahmoodpoor A, Aghamohammadi M, Ahmadi A, Nahreini S, et al. Effect of N-acetylcysteine on microalbuminuria in patients with acute respiratory distress syndrome. Arch Med Sci. 2009; 5(3): 408-14
  • 21. Hendoui N, Beigmohammadi MT, Mahmoodpoor A, Ahmadi A, Abdollahi M, Hasanpour M, et al. Reliability of calcium-binding protein S100B measurement toward optimization of hyperosmolal therapy in traumatic brain injury. Eur Rev Med Pharmacol Sci. 2013; 17(4): 477-85[PubMed]
  • 22. Farhoudi M, Najafi-Nesheli M, Hashemilar M, Mahmoodpoor A, Sharifipour E, Baradaran B, et al. Effect of IMOD on the inflammatory process after acute ischemic stroke: a randomized clinical trial. Daru. 2013; 21(1): 26[DOI][PubMed]
  • 23. Eslami K, Mahmoodpoor A, Ahmadi A, Abdollahi M, Kamali K, Mousavi S, et al. Positive effect of septimeb on mortality rate in severe sepsis: a novel non antibiotic strategy. Daru. 2012; 20(1): 40[DOI][PubMed]
  • 24. Tabeefar H, Beigmohammadi MT, Javadi MR, Abdollahi M, Mahmoodpoor A, Ahmadi A, et al. Effects of Pantoprazole on Systemic and Gastric Pro- and Anti-inflammatory Cytokines in Critically Ill Patients. Iran J Pharm Res. 2012; 11(4): 1051-8[PubMed]
  • 25. Alaei F, Davari PN, Alaei M, Azarfarin R, Soleymani E. Postoperative outcome for hyperglycemic pediatric cardiac surgery patients. Pediatr Cardiol. 2012; 33(1): 21-6
  • 26. Treggiari MM, Karir V, Yanez ND, Weiss NS, Daniel S, Deem SA. Intensive insulin therapy and mortality in critically ill patients. Crit Care. 2008; 12(1)[DOI][PubMed]
  • 27. Wittenberg MD, Gattas DJ, Ryan A, Totaro R. Introduction of intensive glycaemic control into a neurosurgical intensive care unit: a retrospective cohort study. Crit Care Resusc. 2008; 10(3): 203-8[PubMed]
  • 28. Arabi YM, Tamim HM, Rishu AH. Hypoglycemia with intensive insulin therapy in critically ill patients: predisposing factors and association with mortality. Crit Care Med. 2009; 37(9): 2536-44[DOI][PubMed]
  • 29. Faritous Z, Ardeshiri M, Yazdanian F, Jalali A, Totonchi Z, Azarfarin R. Hyperglycemia or high hemoglobin A1C: Which one is more associated with morbidity and mortality after coronary artery bypass graft surgery? Ann Thorac Cardiovasc Surg. 2014; 20(3): 223-8[PubMed]
  • 30. Cryer PE, Davis SN, Shamoon H. Hypoglycemia in Diabetes. Diabetes Care. 2003; 26(6): 1902-12[DOI]
  • 31. Egi M, Bellomo R, Stachowski E, French CJ, Hart GK, Taori G, et al. Hypoglycemia and outcome in critically ill patients. Mayo Clin Proc. 2010; 85(3): 217-24[DOI][PubMed]
  • 32. Finfer S, Heritier S. The NICE-SUGAR (Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation) Study: statistical analysis plan. Crit Care Resusc. 2009; 11(1): 46-57[PubMed]
  • 33. Merimee TJ, Tyson JE. Stabilization of plasma glucose during fasting; Normal variations in two separate studies. N Engl J Med. 1974; 291(24): 1275-8[DOI][PubMed]
  • 34. Azarfarin R, Alizadeh Asl A. Prevalence and intensity of hyperglycemia in non-diabetic patients undergoing coronary artery bypass graft surgery with and without cardiopulmonary bypass. Saudi Med J. 2008; 29(9): 1294-8[PubMed]
  • 35. Andersen SK, Gjedsted J, Christiansen C, Tonnesen E. The roles of insulin and hyperglycemia in sepsis pathogenesis. J Leukoc Biol. 2004; 75(3): 413-21[DOI][PubMed]
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments