The notion that insulin itself is cardiotoxic or vasculotoxic, however, is inconsistent with more recent clinical outcomes, especially those observed in long-term follow-up of studies such as the United Kingdom Prospective Diabetes Study (UKPDS).
However, the more recent COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial found similar CV event rates between patients treated with optimal medical therapy alone and those treated with optimal medical therapy plus percutaneous revascularization.
Although this latter primary outcome measure is less challenging to use in the ED setting, it can now be considered to have been superseded by the more recent FDA-recommended primary outcome measure (reduction in lesion size 48 to 72 h after randomization to treatment).
More recent data reflecting the outcome of new evidence-based interventions in acute myocardial infarction demonstrate that the difference between diabetic and non-diabetic subjects is still present, showing a 1-year mortality in males of 22.3% versus 13.0% in males and 26.1% versus 14.4% in females [ 4].
While early studies focused on the association between higher hospital volume and improved patient outcomes, more recent studies have shown that the association between physician volume and patient outcomes is as strong if not stronger than the hospital volume effect.
Although a systematic review of the literature in 1999 concluded that no study reported pregnancy or the reduction of pain as an outcome [25], more recent work with Interceed® indicated that its effect on reducing adhesions results in improved pregnancy outcomes in infertile patients [29].
More recent data suggest improving outcomes among HIV-infected patients with lung cancer, although survival appears to still be worse than in patients without HIV infection (Hakimian et al, 2007; Suneja et al, 2013).
More recent reports show improved outcomes after CABG in the elderly despite the increased severity of coronary artery disease and increased frequency of comorbid medical conditions in this population.
Despite evidence from a large randomized controlled trial suggesting that tolerating a lower hemoglobin among critically ill patients results in unimpaired outcomes, more recent observational data indicate that adherence to this recommendation is poor across the board, and is worst among patients requiring MV [ 3, 5, 6].
A more recent report detailed the outcomes of a clinical cohort of 26 children with CP, GMFCS V with spasticity and pain in the hip region who had injections of BoNT-A (n = 17 had Dysport®, n = 9 had Botox®) to improve comfort [ 21].
