Analytic Review: Glucose Controversies in the ICU

Hyperglycemia is common in critical illness and has been associated with increased morbidity and mortality. An era of tight glucose control began when intensive insulin therapy was shown to improve outcomes in a single-center randomized trial. More recently, with the publication of additional studie...

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Bibliographic Details
Published in:Journal of Intensive Care Medicine 2011-05, Vol.26 (3), p.135-150
Main Authors: Honiden, Shyoko, Inzucchi, Silvio E.
Format: Article
Language:English
Subjects:
Blood Glucose
Critical Illness
Humans
Hyperglycemia - drug therapy
Hypoglycemia - drug therapy
Hypoglycemic Agents - adverse effects
Hypoglycemic Agents - therapeutic use
Insulin - adverse effects
Insulin - therapeutic use
Intensive Care Units
Risk Factors
Treatment Outcome
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Summary:Hyperglycemia is common in critical illness and has been associated with increased morbidity and mortality. An era of tight glucose control began when intensive insulin therapy was shown to improve outcomes in a single-center randomized trial. More recently, with the publication of additional studies, questions have been raised regarding the efficacy and safety of intensive glycemic management. This article will review the biologic mechanisms that may help us understand why and how hyperglycemia and insulin are relevant in critical illness. We will then explore insights gleaned from available clinical trials. Finally, we will discuss specific areas of controversy that relate to the implementation of glycemic control in the intensive care unit, such as the ideal glucose target and the importance of hypoglycemia.
ISSN:0885-0666
1525-1489
DOI:10.1177/0885066610387892