Glucose Control in the ICU

Abstract

During the last 2 decades, the treatment of hyperglycemia in critically ill patients has become one of the most discussed topics in the intensive medicine field. The initial data suggesting significant benefit of normalization of blood glucose levels in critically ill patients using intensive intravenous insulin therapy have been challenged or even neglected by some later studies. At the moment, the need for glucose control in critically ill patients is generally accepted yet the target glucose values are still the subject of ongoing debates. In this review, we summarize the current data on the benefits and risks of tight glucose control in critically ill patients focusing on the novel technological approaches including continuous glucose monitoring and its combination with computer-based algorithms that might help to overcome some of the hurdles of tight glucose control. Since increased risk of hypoglycemia appears to be the major obstacle of tight glucose control, we try to put forward novel approaches that may help to achieve optimal glucose control with low risk of hypoglycemia. If such approaches can be implemented in real-world practice the entire concept of tight glucose control may need to be revisited.

The Clinical Benefits and Accuracy of Continuous Glucose Monitoring Systems in Critically Ill Patients—A Systematic Scoping Review

“…Nowadays, consensus states that hyperglycemia in critically ill patients should be monitored and treated, with guidelines recommending glucose levels between 100 and 150 mg/dL (Society of Critical Care Medicine [ 19 ]) or between 140 and 180 mg/dL (American Diabetes Association [ 20 ]). However, tighter ranges might be feasible when the average ICU has the ability to safely control glucoses in such a range [ 21 ].…”