Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2025; 16(7): 107767
Published online Jul 15, 2025. doi: 10.4239/wjd.v16.i7.107767
Impact of intensive insulin therapy on dynamic cardiac function in critically ill patients with stress-induced hyperglycemia
Yu-Dan Wang, Jing-Jing Yu
Yu-Dan Wang, Department of Critical Care Medicine, The First Affiliated Hospital of Ningbo University, Ningbo 315300, Zhejiang Province, China
Jing-Jing Yu, Department of Critical Care Medicine, The Second People's Hospital of Beilun District, Ningbo 315809, Zhejiang Province, China
Author contributions: Wang YD and Yu JJ contributed to the conceptualization of the study; Wang YD was responsible for data curation, formal analysis, and methodology, as well as managing resources and software; Wang YD also wrote the original draft of the manuscript; Yu JJ provided valuable input in reviewing and editing the manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of The First Affiliated Hospital of Ningbo University (2025-KY2501100013).
Informed consent statement: Informed consent was obtained from all subjects and/or their legal guardian(s). Patients and/or families in the study provided consent for the publication of their data.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets used and/or analyzed during the present study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing-Jing Yu, MD, Department of Critical Care Medicine, The Second People's Hospital of Beilun District, No. 2 Chaiwei Road, Chaiqiao Street, Beilun District, Ningbo 315809, Zhejiang Province, China. yhac18@163.com
Received: March 30, 2025
Revised: May 1, 2025
Accepted: June 9, 2025
Published online: July 15, 2025
Processing time: 109 Days and 0.5 Hours
Abstract
BACKGROUND

Stress-induced hyperglycemia (SIH) is common in critically ill patients and has been associated with adverse cardiovascular outcomes. Intensive insulin therapy (IIT) has been proposed to mitigate these risks by achieving tighter glycemic control.

AIM

To evaluate the efficacy of IIT for managing SIH in critically ill patients and to explore its potential effect on cardiac function.

METHODS

A retrospective study was conducted at our hospital from January 2021 to December 2024, adhering to STROBE guidelines. A total of 186 critically ill patients were divided into normal glycemia (n = 85) and SIH (n = 101) groups. The SIH cohort was further subdivided into conventional treatment (n = 50) and IIT (n = 51) groups. Hemodynamic parameters-including right atrial pressure (RAP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PAWP), cardiac output (CO), cardiac index (CI), and B-type natriuretic peptide (BNP)-were measured at baseline and post-treatment. Clinical outcomes such as intensive care unit (ICU) length of stay, mechanical ventilation requirements, and mortality were also recorded. Statistical analyses were conducted using independent samples t-tests and χ2/Fisher’s exact tests.

RESULTS

SIH markedly worsened haemodynamics versus normal glycaemia: RAP 9.8 ± 5.1 vs 6.1 ± 3.5 mmHg, PAP 35.2 ± 16.0 vs 26.2 ± 10.3 mmHg, PAWP 16.0 ± 7.0 vs 8.6 ± 6.4 mmHg, CO 3.3 ± 2.3 vs 6.0 ± 3.3 L/min, CI 1.88 ± 0.24 vs 2.70 ± 0.50 L/min/m2, BNP 465 ± 250 vs 180 ± 53 pg/mL (all P < 0.001). Within the SIH cohort, IIT outperformed conventional therapy: RAP 7.0 ± 2.2 vs 8.3 ± 3.9 mmHg (P = 0.04), PAP 21.6 ± 3.7 vs 29.3 ± 6.5 mmHg (P < 0.001), PAWP 10.2 ± 5.4 vs 13.8 ± 5.3 mmHg (P = 0.001), CO 4.9 ± 2.2 vs 4.0 ± 1.4 L/min (P = 0.022), CI 2.58 ± 0.32 vs 2.11 ± 0.31 L/min/m2, P < 0.001), BNP 202 ± 62 vs 346 ± 171 pg/mL (P < 0.001). Clinically, IIT shortened ICU stay (10.3 ± 3.4 vs 14.5 ± 2.6 days, P < 0.001), reduced ventilator use (56.9% vs 76.0%, P = 0.042), and lowered mortality (23.5% vs 42.0%, P = 0.048).

CONCLUSION

IIT significantly reduced cardiac filling pressures, improved cardiac function, and was associated with favorable clinical outcomes in SIH patients, suggesting potential benefits of stricter glycaemic control in critically ill patients. However, given the retrospective design and absence of glucose-variability monitoring, these findings should be interpreted with caution.

Keywords: Intensive insulin therapy; Stress-induced hyperglycemia; Cardiac function; Critically ill patients; Intensive care unit

Core Tip: In this study, we aim to explore the effects of intensive insulin therapy (IIT) on cardiac function and clinical outcomes in critically ill patients with stress-induced hyperglycemia. Our findings demonstrate that IIT can significantly improve myocardial performance, reduce hemodynamic stress markers, and result in better clinical outcomes, including shorter intensive care unit (ICU) stays and reduced mortality rates. These findings underscore the potential benefits of stricter glycemic control in the ICU setting, which may ultimately enhance patient recovery and reduce complications.