Published online Mar 15, 2017. doi: 10.4239/wjd.v8.i3.89
Peer-review started: August 29, 2016
First decision: November 11, 2016
Revised: November 30, 2016
Accepted: December 27, 2016
Article in press: December 29, 2016
Published online: March 15, 2017
Disorders of glucose homeostasis, such as stress-induced hypoglycemia and hyperglycemia, are common complications in patients in the intensive care unit. Patients with preexisting diabetes mellitus (DM) are more susceptible to hyperglycemia, as well as a higher risk from glucose overcorrection, that may results in severe hypoglycemia. In critically ill patients with DM, it is recommended to maintain a blood glucose range between 140-180 mg/dL. In neurological patients and surgical patients, tighter glycemic control (i.e., 110-140 mg/d) is recommended if hypoglycemia can be properly avoided. There is limited evidence that shows that critically ill diabetic patients with a glycosylated hemoglobin levels above 7% may benefit from looser glycemic control, in order to reduce the risk of hypoglycemia and significant glycemic variability.
Core tip: Diabetes mellitus is a common comorbidity found in critically ill patients. Although strict glycemic control in the past was considered a standard therapeutic intervention, newer clinical trials have shown that moderate glycemic control (i.e., glucose levels between 140-180 mg/dL) reduces mortality and morbidity in such patients.