Sixteen RCTs (n>5,372) were included in the review.
GIK regimen (10 studies, n=1,696).
Compared with the control treatment, 5 studies found an improved myocardial performance with GIK; two of these also found shorter hospital stays. The remaining studies reported no clinical advantage or even suggested a higher mortality with the GIK therapy.
Intensive insulin-based therapy (5 studies, n>3,056).
Three of the included trials showed favourable effects of the regimen on morbidity and/or mortality, and two found no significant benefit. Among critically-ill patients, intensive insulin therapy was associated with a statistically significant reduction in intensive care mortality (4.6% versus 8.0%, p<0.04) and in-hospital mortality (7.2% versus 10.9%, p=0.01) in comparison with conventional insulin therapy (1 study). These benefits were observed only in the subgroup hospitalised for longer than 5 days (10.6% versus 20.2%, p=0.01).
In a prospective, randomised controlled study of adult patients admitted to the intensive care unit, the intention-to-treat analysis showed comparable in-hospital mortality between intensive and conventional insulin therapy (37.3% and 40.0%, respectively, p=0.33).
One RCT (n=620) evaluated an insulin-glucose infusion therapy followed by subcutaneous insulin for more than 3 months in diabetic patients with acute myocardial infarction. Compared with conventional insulin therapy, the insulin-glucose infusion was associated with a statistically significant lower 1-year mortality.