Effect of Glucose—Insulin—Potassium Infusion on Mortality in Critical Care Settings: A Systematic Review and Meta‐Analysis

This study seeks to measure the treatment effect of glucose—insulin—potassium (GIK) infusion on mortality in critically ill patients. A systematic review of randomized controlled trials is conducted, comparing GIK treatment with standard care or placebo in critically ill adult patients. The primary outcome variable is mortality. Two authors independently extract data and assess study quality. The primary analysis is based on the random effects model to produce pooled odds ratios (ORs) with 95% confidence intervals (CIs). The search yields 1720 potential publications; 23 studies are included in the final analysis, providing a sample of 22 525 patients. The combined results demonstrate no heterogeneity (P = .57, I2 = 0%) and no effect on mortality (OR = 1.02; 95% CI, 0.93–1.11) with GIK treatment. No experimental studies of shock or sepsis populations are identified. This meta‐analysis finds that there is no mortality benefit to GIK infusion in critically ill patients; however, study populations are limited to acute myocardial infarction and cardiovascular surgery patients. No studies are identified using GIK in patients with septic shock or other forms of circulatory shock, providing an absence of evidence regarding the effect of GIK as a therapy in patients with shock.

[1]  E. de Jonge,et al.  Perioperative hyperinsulinaemic normoglycaemic clamp causes hypolipidaemia after coronary artery surgery. , 2008, British journal of anaesthesia.

[2]  David Moher,et al.  Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews , 2007, BMC medical research methodology.

[3]  J. Townend,et al.  Glucose-Insulin-Potassium and Tri-Iodothyronine Individually Improve Hemodynamic Performance and Are Associated With Reduced Troponin I Release After On-Pump Coronary Artery Bypass Grafting , 2006, Circulation.

[4]  E. Gams,et al.  Forty years of glucose-insulin-potassium (GIK) in cardiac surgery: a review of randomized, controlled trials. , 2006, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[5]  H. Montgomery,et al.  Glucose-insulin and potassium infusions in septic shock. , 2006, Chest.

[6]  张磊,et al.  The effects of high dose glucose-insulin-potassium on hemodynamics in patients with acute myocardial infarction , 2006 .

[7]  J. Townend,et al.  Improved myocardial protection during coronary artery surgery with glucose-insulin-potassium: a randomized controlled trial. , 2006, The Journal of thoracic and cardiovascular surgery.

[8]  J. Marinković,et al.  Effects of glucose-insulin-potassium infusion on ST-elevation myocardial infarction in patients treated with thrombolytic therapy. , 2005, The American journal of cardiology.

[9]  Christopher H Schmid,et al.  In an empirical evaluation of the funnel plot, researchers could not visually identify publication bias. , 2005, Journal of clinical epidemiology.

[10]  J. Koskenkari,et al.  Metabolic and hemodynamic effects of high-dose insulin treatment in aortic valve and coronary surgery. , 2005, The Annals of thoracic surgery.

[11]  Jun Zhu,et al.  Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: the CREATE-ECLA randomized controlled trial. , 2005, JAMA.

[12]  M. Olschewski,et al.  Glucose-insulin-potassium in cardiac surgery: a meta-analysis. , 2004, The Annals of thoracic surgery.

[13]  J. Lau,et al.  Insulin therapy for critically ill hospitalized patients: a meta-analysis of randomized controlled trials. , 2004, Archives of internal medicine.

[14]  S. Nekolla,et al.  A randomized evaluation of the effects of glucose-insulin-potassium infusion on myocardial salvage in patients with acute myocardial infarction treated with reperfusion therapy. , 2004, American heart journal.

[15]  Howard Cabral,et al.  Tight Glycemic Control in Diabetic Coronary Artery Bypass Graft Patients Improves Perioperative Outcomes and Decreases Recurrent Ischemic Events , 2004, Circulation.

[16]  T. Vary,et al.  Sepsis alters pyruvate dehydrogenase kinase activity in skeletal muscle , 1999, Molecular and Cellular Biochemistry.

[17]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[18]  B. Riedel,et al.  Coronary revascularization: a procedure in transition from on-pump to off-pump? The role of glucose-insulin-potassium revisited in a randomized, placebo-controlled study. , 2002, Journal of cardiothoracic and vascular anesthesia.

[19]  D. McGiffin,et al.  Glucose-insulin-potassium infusion for myocardial protection during off-pump coronary artery surgery. , 2002, The Annals of thoracic surgery.

[20]  A. Bengtsson,et al.  Insulin (GIK) improves central mixed and hepatic venous oxygenation in clinical cardiac surgery. , 2001, Scandinavian cardiovascular journal : SCJ.

[21]  John E. Hunter,et al.  Fixed Effects vs. Random Effects Meta‐Analysis Models: Implications for Cumulative Research Knowledge , 2000 .

[22]  S. Chipkin,et al.  Glucose-insulin-potassium solutions improve outcomes in diabetics who have coronary artery operations. , 2000, The Annals of thoracic surgery.

[23]  J. L. Tang,et al.  Misleading funnel plot for detection of bias in meta-analysis. , 2000, Journal of clinical epidemiology.

[24]  K. Beatt,et al.  Glucose-insulin-potassium therapy for treatment of acute myocardial infarction: an overview of randomized placebo-controlled trials. , 1997, Circulation.

[25]  R. Shemin,et al.  Glucose-insulin-potassium solutions enhance recovery after urgent coronary artery bypass grafting. , 1997, The Journal of thoracic and cardiovascular surgery.

[26]  T. Vary SEPSIS‐INDUCED ALTERATIONS IN PYRUVATE DEHYDROGENASE COMPLEX ACTIVITY IN RAT SKELETAL MUSCLE: EFFECTS ON PLASMA LACTATE , 1996, Shock.

[27]  J. Parrillo,et al.  Tumor necrosis factor alpha and interleukin 1beta are responsible for in vitro myocardial cell depression induced by human septic shock serum , 1996, The Journal of experimental medicine.

[28]  O. Frazier,et al.  Efficacy of metabolic support with glucose-insulin-potassium for left ventricular pump failure after aortocoronary bypass surgery. , 1989, Circulation.

[29]  W. Law,et al.  Myocardial Insulin Resistance During Acute Endotoxin Shock in Dogs , 1988, Diabetes.

[30]  W. Law,et al.  Effect of insulin on myocardial contractility during canine endotoxin shock. , 1988, Cardiovascular research.

[31]  W. Mauritz,et al.  [Glucose-potassium-insulin in hypodynamic septic shock]. , 1986, Der Anaesthesist.

[32]  J. Siegel,et al.  Effect of sepsis on activity of pyruvate dehydrogenase complex in skeletal muscle and liver. , 1986, The American journal of physiology.

[33]  L. Opie,et al.  Effects of preoperative glucose-insulin-potassium on myocardial glycogen levels and on complications of mitral valve replacement. , 1986, The Journal of thoracic and cardiovascular surgery.

[34]  G. C. van den Bos,et al.  Use of glucose‐insulin‐potassium (GIK) in human septic shock , 1985, Critical care medicine.

[35]  G. C. van den Bos,et al.  Effects of glucose-insulin-potassium (GIK) on myocardial blood flow and metabolism in canine endotoxin shock. , 1984, Circulatory shock.

[36]  K. Kobayashi,et al.  Effects of increased cardiac work on pyruvate dehydrogenase activity in hearts from diabetic animals. , 1983, Journal of molecular and cellular cardiology.

[37]  L. Thijs,et al.  Effects of glucose-insulin-potassium (GIK) on the position of the oxyhemoglobin dissociation curve, 2.3-diphosphoglycerate, and oxygen consumption in canine endotoxin shock. , 1983, The Journal of surgical research.

[38]  G. C. van den Bos,et al.  Ventricular function, hemodynamics, and oxygen consumption during infusions of blood and glucose-insulin-potassium (GIK) in canine endotoxin shock. , 1982, Circulatory shock.

[39]  L. Smith,et al.  Clinical effects of glucose-insulin-potassium on left ventricular function in acute myocardial infarction: results from a randomized clinical trial. , 1981, American heart journal.

[40]  J. Vincent,et al.  INFUSION OF GLUCOSE AND INSULIN IN CIRCULATORY SHOCK , 1981 .

[41]  P. Sugden,et al.  Regulation of pyruvate dehydrogenase by insulin action. , 1979, Progress in clinical and biological research.

[42]  H. Hechtman,et al.  Effect of glucose-insulin-postassium on survival in experimental endotoxic shock. , 1978, Surgery, gynecology & obstetrics.

[43]  M. D. Lond. Norman Swift Plummer. , 1978, Lancet.

[44]  L. Hinshaw,et al.  Reversal of myocardial dysfunction in endotoxin shock with insulin. , 1978, Canadian journal of physiology and pharmacology.

[45]  T. O'donnell,et al.  Myocardial performance in clinical septic shock: effects of isoproterenol and glucose potassium insulin. , 1975, Journal of Surgical Research.

[46]  T. O'donnell,et al.  Energy Metabolism in Sepsis: Treatment Based on Different Patterns in Shock and High Output Stage , 1974, Annals of surgery.

[47]  J. Degaute,et al.  [Significance of the "polarizing" treatment of myocardial infarct]. , 1974, Acta cardiologica.

[48]  B. Pentecost,et al.  Controlled trial of intravenous glucose, potassium, and insulin in acute myocardial infarction. , 1968, Lancet.

[49]  D. Sodi-Pallares,et al.  Effects of an intravenous infusion of a potassium-glucose-insulin solution on the electrocardiographic signs of myocardial infarction. A preliminary clinical report. , 1962, The American journal of cardiology.