Assessment and treatment of hyperglycemia in critically ill patients

Abstract

Hyperglycemia is a commonly encountered issue in critically ill patients in the intensive care setting. The presence of hyperglycemia is associated with increased morbidity and mortality, regardless of the reason for admission (e.g., acute myocardial infarction, status post-cardiovascular surgery, stroke, sepsis). However, the pathophysiology and, in particular, the treatment of hyperglycemia in the critically ill patient remain controversial. In clinical practice, several aspects must be taken into account in the management of these patients, including blood glucose targets, history of diabetes mellitus, the route of nutrition (enteral or parenteral), and available monitoring equipment, which substantially increases the workload of providers involved in the patients' care. This review describes the epidemiology, pathophysiology, management, and monitoring of hyperglycemia in the critically ill adult patient.

Insulin Regimens to Treat Hyperglycemia in Hospitalized Patients on Nutritional Support: Systematic Review and Meta-Analyses

“…The risk of hospital complications increases with illness severity and also in patients without a previous history of diabetes [1]. The mechanism underlying hyperglycemia during acute illness is complex and includes the release of counter-regulatory hormones (corticosteroids and catecholamines) and proinflammatory mediators and administration of exogenous corticosteroids, vasopressors, and enteral and parenteral nutrition [2]. …”

Glycemic control strategies and the occurrence of surgical site infection: a systematic review

“…The studies included in this review seem to agree that maintaining blood glucose between 80 and 120 mg/dL is associated with lower rates of complications in the postoperative period and hence, lower costs for the hospital (8,(10)(11)(16)(17)(18)(19)(21)(22) . It is noteworthy that less cautious models of glycemic control were independently associated to a higher incidence of SSI (26) .…”

“…Coupled with DM, hyperglycemia is a frequent problem encountered in patients in critical condition and/ or undergoing surgical procedures. It is a cause of morbidity and mortality due to physiological abnormalities of healing, vascular and neuropathic complications, and inhibition of these individuals' defense system, making them more aggressively exposed to the risk of SSIs (10)(11) . Hyperglycemia can be defined as the abnormal increase in blood glucose levels, greater than 140 mg/dL in patients with no history of diabetes or absence of changes in glycated hemoglobin levels (10)(11) .…”

“…It is a cause of morbidity and mortality due to physiological abnormalities of healing, vascular and neuropathic complications, and inhibition of these individuals' defense system, making them more aggressively exposed to the risk of SSIs (10)(11) . Hyperglycemia can be defined as the abnormal increase in blood glucose levels, greater than 140 mg/dL in patients with no history of diabetes or absence of changes in glycated hemoglobin levels (10)(11) . The aim of the present study was to analyze the available evidence in the scientific literature regarding the relationship between glycemic control strategies used and the occurrence of surgical site infection in adult patients undergoing surgery, and identify gaps in the scientific knowledge produced so far to point recommendations for future research.…”

Management of critically ill patients with diabetes

“…In non-diabetic patients, SIH has been arbitrarily defined as a blood glucose level greater than 140 mg/dL or glycosylated hemoglobin (HbA1c) greater than 6.5%[15]. In diabetic patients, SIH is be defined as blood glucose levels greater than 180-220 mg/dL[15].…”