INS and Shock: In the COIITSS trial, a two-by-two multifactorial open-label study comparing continuous intravenous insulin infusion with conventional insulin therapy as well as hydrocortisone plus fludrocortisone with hydrocortisone monotherapy in patients with septic shock and multiple organ dysfunction, there was a 2.9% absolute reduction in hospital mortality in the combination therapy group (n = 245) compared to the hydrocortisone monotherapy group (n = 264) [49]; however, this trial was statistically underpowered.