cal Intensive Care Medicine (A.W., G.H.,

Intensive insulin therapy reduces morbidity and mortality in patients in surgical in-tensive care units (ICUs), but its role in patients in medical ICUs is unknown. Methods In a prospective, randomized, controlled study of adult patients admitted to our medical ICU, we studied patients who were considered to need intensive care for at least three days. On admission, patients were randomly assigned to strict normal-ization of blood glucose levels (80 to 110 mg per deciliter [4.4 to 6.1 mmol per liter]) with the use of insulin infusion or to conventional therapy (insulin administered when the blood glucose level exceeded 215 mg per deciliter [12 mmol per liter], with the infusion tapered when the level fell below 180 mg per deciliter [10 mmol per liter]). There was a history of diabetes in 16.9 percent of the patients. Results In the intention-to-treat analysis of 1200 patients, intensive insulin therapy reduced blood glucose levels but did not significantly reduce in-hospital mortality (40.0 per-cent in the conventional-treatment group vs. 37.3 percent in the intensive-treatmen