Article Summary Insulin Therapy for Critically Ill Hospitalized Patients, A Meta-analysis of Randomized Controlled Trials. Pittas AG, Siegel RD, Lau J. Arch Intern Med. 2004;164:2005-2011. Objective: To assess the effect of insulin therapy on mortality in adult patients hospitalized for acute myocardial infarction, coronary artery bypass grafting, stroke, or an illness that required admission to an intensive care unit. Methods: MEDLINE and Cochrane Controlled Clinical Trials Register searches were performed (January 1996 to April 2003 and April to June 2003, respectively) to analyze randomized controlled trials of insulin administration in critically ill hospitalized adults. Key search terms included CABG, clinical trial, coronary artery bypass, glucose-insulin-potassium, hospital, human, hyperglycemia, insulin, intensive care unit, mortality, myocardial infarction, and stroke. Patients for whom insulin therapy would be clearly indicated (eg, severe or unstable hyperglycemia on admission) were excluded from all studies. Relative risk reduction of mortality was the primary measure of the effect of insulin on treatment. Trials in which the goal of insulin therapy was to achieve glucose control were compared with trials in which insulin was administered with no target glucose goal. Data from all trials were combined using a random-effects model. Results: Thirty-five randomized controlled trials were included in the final meta-analysis, with each study contributing 1 result. Trials that targeted glucose control resulted in a 29% reduction in mortality compared with controls. No benefit was seen when insulin was administered without regard to glucose levels. Conclusion: New-onset inpatient hyperglycemia is often an adaptive response caused by increased insulin resistance during periods of stress. Stress hyperglycemia is considered an acute marker of the severity of illness in patients not previously diagnosed with diabetes. In these studies, in-hospital hyperglycemia was associated with adverse outcomes, including mortality.