Dysglycemia in the critically ill patient: current evidence and future perspectives

Abstract

Dysglycemia in critically ill patients (hyperglycemia, hypoglycemia, glycemic variability and time in range) is a biomarker of disease severity and is associated with higher mortality. However, this impact appears to be weakened in patients with previous diabetes mellitus, particularly in those with poor premorbid glycemic control; this phenomenon has been called "diabetes paradox". This phenomenon determines that glycated hemoglobin (HbA1c) values should be considered in choosing glycemic control protocols on admission to an intensive care unit and that patients' target blood glucose ranges should be adjusted according to their HbA1c values. Therefore, HbA1c emerges as a simple tool that allows information that has therapeutic utility and prognostic value to be obtained in the intensive care unit.

Prognostic Significance of Blood Glucose Levels and Alterations Among Patients with Aluminium Phosphide Poisoning

“…According to international recommendations, blood glucose levels should be maintained at 140-180 mg/dL for normoglycaemic patients and 180-200 mg/dL for previously diabetic individuals. 20 Both the hypoand hyperglycaemic effects of AlP are attributable to the wide variety of changes in magnesium, calcium, phosphate, citrate and cortisol levels that result from AlP poisoning. 11,21 These biochemical changes can act as either stimulatory or inhibitory modulators of the enzymes and hormones that catalyse and regulate the metabolism of glucose.…”

“…23 Among critically-ill patients, blood glucose alterations have been associated with prolonged hospital stays as well as increased mortality. 20,24 However, to the best of the authors' knowledge, only one previous study has examined the relationship between hyperglycaemia and AlP poisoning outcomes. Mehrpour et al published a prospective study of 45 patients with acute AlP poisoning, of which 32 patients (71%) died.…”

Association Between Glucose Variability And Postoperative Delirium In Acute Aortic Dissection Patients: An Observational Study

“…In recent years, more attention has been paid to the study of blood glucose variability (GV) on disease progression and prognosis of patients, and it has important clinical signi cance for monitoring and controlling of blood GV in severe patients 9,10 . Compared with hyperglycemia, blood GV better re ects changes in the condition and has greater adverse effects on the body, which may have higher clinical value 10,11 . It is well known that blood GV increases the risk of adverse events after cardiac surgery, such as acute kidney injury, and the risk of short-term and long-term death 12,13 .…”

The Long and Winding Road to Personalized Glycemic Control in the Intensive Care Unit

“…In the critically ill adult, dysglycemia is a marker of disease severity and is associated with worse clinical outcomes. 1 The common practice of close monitoring of glucose in critical illness and management using insulin finds its roots in the seminal randomized study by van den Berghe and colleagues in 2001 2 which showed a 42% decrease in mortality with tight glucose control (TGC; 80-110 mg/dL) in patients who remained in the surgical critical care unit for a period over 5 days. However, a similar trial by the authors in the medical intensive care unit (ICU) did not replicate the same mortality benefit.…”