Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Diabetes. Jul 15, 2012; 3(7): 130-134
Published online Jul 15, 2012. doi: 10.4239/wjd.v3.i7.130
Glycemia management in critical care patients
Federico Bilotta, Giovanni Rosa
Federico Bilotta, Giovanni Rosa, Department of Anesthesiology, Critical Care and Pain Medicine, Section of Neuroanesthesia and Neurocritical Care, “Sapienza” University of Rome, 00199 Rome, Italy
Federico Bilotta, Clinical Anesthesiology, Albert Einstein College of Medicine, New York, NY 10461, United States
Author contributions: Bilotta F designed the manuscript and wrote the paper and Rosa G revised the manuscript.
Correspondence to: Dr. Federico Bilotta, MD, PhD, Department of Anesthesiology, Critical Care and Pain Medicine, “Sapienza” University of Rome, Via Acherusio 16, 00199 Rome, Italy. bilotta@tiscali.it
Telephone: +39-6-8608273 Fax: +39-6-8608273
Received: May 3, 2012
Revised: May 22, 2012
Accepted: June 10, 2012
Published online: July 15, 2012

Over the last decade, the approach to clinical management of blood glucose concentration (BGC) in critical care patients has dramatically changed. In this editorial, the risks related to hypo, hyperglycemia and high BGC variability, optimal BGC target range and BGC monitoring devices for patients in the intensive care unit (ICU) will be discussed. Hypoglycemia has an increased risk of death, even after the occurrence of a single episode of mild hypoglycemia (BGC < 80 mg/dL), and it is also associated with an increase in the ICU length of stay, the major determinant of ICU costs. Hyperglycemia (with a threshold value of 180 mg/dL) is associated with an increased risk of death, longer length of stay and higher infective morbidity in ICU patients. In ICU patients, insulin infusion aimed at maintaining BGC within a 140-180 mg/dL target range (NICE-SUGAR protocol) is considered to be the state-of-the-art. Recent evidence suggests that a lower BGC target range (129-145 mg/dL) is safe and associated with lower mortality. In trauma patients without traumatic brain injury, tight BGC (target < 110 mg/dL) might be associated with lower mortality. Safe BGC targeting and estimation of optimal insulin dose titration should include an adequate nutrition protocol, the length of insulin infusion and the change in insulin sensitivity over time. Continuous glucose monitoring devices that provide accurate measurement can contribute to minimizing the risk of hypoglycemia and improve insulin titration. In conclusion, in ICU patients, safe and effective glycemia management is based on accurate glycemia monitoring and achievement of the optimal BGC target range by using insulin titration, along with an adequate nutritional protocol.

Keywords: Glycemia management, Intensive insulin therapy, Hyperglycemia, Hypoglycemia, Metabolism, Intensive care