Update on glucose in critical care

•Stress hyperglycemia occurs frequently during critical illness as a result of increased resistance to insulin.•The three domains of dysglycemia—stress hyperglycemia, hypoglycemia, and high glycemic variability—are associated with a poor outcome.•The risk-to-benefit ratio of intensive insulin therap...

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Bibliographic Details
Published in:Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2019-03, Vol.59, p.14-20
Main Authors: Lheureux, Olivier, Prevedello, Danielle, Preiser, Jean-Charles
Format: Article
Language:English
Subjects:
Blood Glucose - drug effects
Clinical outcomes
Clinical trials
Clinical Trials as Topic
Closed loop systems
Critical care
Critical Care - methods
Critical Illness - therapy
Cytokines
Diabetes
Diabetes mellitus
Dysglycemia
Glucose
Glucose - therapeutic use
Glucose monitoring
Hormones
Humans
Hyperglycemia
Hyperglycemia - blood
Hyperglycemia - drug therapy
Hyperglycemia - etiology
Hypoglycemia
Hypoglycemic Agents - therapeutic use
Illnesses
Insulin resistance
Insulin therapy
Intensive care
Liver
Meta-analysis
Meta-Analysis as Topic
Metabolic stress
Metabolism
Mortality
Prospective Studies
Stress hyperglycemia
Stress response
Stress, Physiological - physiology
Studies
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Summary:•Stress hyperglycemia occurs frequently during critical illness as a result of increased resistance to insulin.•The three domains of dysglycemia—stress hyperglycemia, hypoglycemia, and high glycemic variability—are associated with a poor outcome.•The risk-to-benefit ratio of intensive insulin therapy aiming at a blood glucose target ranging from 80 to 110 mg/dL have not been found beneficial in most interventional studies.•Glycemic control titrated to reach liberal glycemic ranges of blood glucose and personalized targets are currently investigated in clinical trials. The aim of this review is to summarize recent developments on the mechanisms involved in stress hyperglycemia associated with critical illness. Different aspects of the consequences of stress hyperglycemia as well as the therapeutic approaches tested so far are discussed: the physiological regulations of blood glucose, the mechanisms underlying stress hyperglycemia, the clinical associations, and the results of the prospective trials and meta-analyses to be taken into consideration when interpreting the available data. Current recommendations, challenges, and technological hopes for the future are be discussed.
ISSN:0899-9007
1873-1244
DOI:10.1016/j.nut.2018.06.027