Current status of tight blood sugar control

Abstract

This review describes the current status and the clinical data related to the effects of tight glucose control in critically ill patients. In contrast to decreases in mortality and morbidity reported in one study in which insulin rate was titrated to keep blood glucose between 80 and 110 mg/dL, the benefits were not confirmed in multicenter prospective studies. Retrospective data found an association between a mean blood glucose level below 140 to 150 mg/dL and improved outcome. Currently unanswered issues include the optimal target for blood glucose, effects of blood glucose variability, hazards of hypoglycemia, and potential influence of the underlying disorder on the effects of tight glucose control. Therefore, recommendations regarding practical aspects of tight glucose control by intensive insulin therapy cannot be supported by currently available data. An intermediate target level for blood glucose of 140 to 180 mg/dL seems associated with the lowest risk-to-benefit ratio.

Systemic Glucose and Brain Energy Metabolism after Subarachnoid Hemorrhage

“…Recently, a more liberal approach with serum glucose levels between 7.8 and 10.0 mmol/l was suggested [23,24], as the benefits of tight glycemic control were not confirmed in multicenter prospective studies [12]. In line with that, tight glycemic control was significantly associated with increased incidence of brain MC and poor outcome in patients with severe brain injury [13].…”

Blood glucose control using a computer-guided glucose management system in allogeneic hematopoietic cell transplant recipients

“…[1][2][3] Recently, efforts have been made to control hyperglycemia during hospitalization, but results from clinical trials and retrospective analyses have demonstrated inconsistent outcomes associated with intensive insulin therapy. [4][5][6][7][8][9][10][11][12] There is also evidence that severe hypoglycemia (glucose o40 mg/dL) in hospitalized patients may have a detrimental effect on outcomes, including cardiac arrest, seizures, hypoglycemia-induced coma and mortality, 5,[13][14][15][16][17] thus limiting the efforts for meticulous glucose control in the hospital. In addition, recent evidence also suggests that glucose variability can be detrimental and increase mortality risk in hospitalized patients.…”