Glycemic control in non-diabetic critically ill patients

• Published in: Baillière's best practice & research. Clinical endocrinology & metabolism 2011-10, Vol.25 (5), p.813-824
• Main Authors: Farrokhi, Farnoosh, MD, Smiley, Dawn, MD, Umpierrez, Guillermo E., MD
• Format: Article
• Language: English
• Subjects: Endocrinology & Metabolism; hospital hyperglycemia; ICU; inpatient hyperglycemia; stress hyperglycemia
• ISSN: 1521-690X; 1878-1594
• DOI: 10.1016/j.beem.2011.05.004

Hyperglycemia is a common and costly health care problem in hospitalized patients. In hospital hyperglycemia is defined as any glucose value >7.8 mmol/l (140 mg/dl). Hyperglycemia is present in 40% of critically ill patients and in up to 80% of patients after cardiac surgery, with ∼ 80% of ICU patients with hyperglycemia having no history of diabetes prior to admission. The risk of hospital complications relates to the severity of hyperglycemia, with a higher risk observed in patients without a history of diabetes compared to those with known diabetes. Improvement in glycemic control reduces hospital complications and mortality; however, the ideal glycemic target has not been determined. A target glucose level between 7.8 and 10.0 mmol/l (140 and 180 mg/dl) is recommended for the majority of ICU patients. This review aims to present updated recommendations for the inpatient management of hyperglycemia in critically ill patients with and without a history of diabetes.