Editorial
Copyright ©2009 Baishideng. All rights reserved.
World J Gastrointest Surg. Nov 30, 2009; 1(1): 3-5
Published online Nov 30, 2009. doi: 10.4240/wjgs.v1.i1.3
Glycemic control in critically ill patients: What to do post NICE-SUGAR?
Paul E Marik
Paul E Marik, Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States
Author contributions: Marik PE contributed solely to this editorial.
Correspondence to: Paul E Marik, MD, FCCP, FCCM, Professor of Medicine, Chief of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States. marikpe@evms.edu
Telephone: +1-757-4468910 Fax: +1-757-4465242
Received: July 2, 2009
Revised: November 9, 2009
Accepted: November 16, 2009
Published online: November 30, 2009
Abstract

Until recently, stress hyperglycemia was considered to be a beneficial adaptive response, with raised blood glucose providing a ready source of fuel for the brain, skeletal muscle, heart and other vital organs at a time of increased metabolic demand. Following the Leuven Intensive Insulin Therapy Trial in 2001, tight glycemic control became rapidly adopted as the standard of care in intensive care units (ICU’s) throughout the world. However, four randomized controlled studies and the recently published NICE-SUGAR study have subsequently been unable to replicate the findings of the Leuven Intensive Insulin Therapy Trial. This paper offers an explanation for these discordant findings, and provides a practical approach to glucose control in the ICU.

Keywords: Stress hyperglycemia, Intensive care, Critical care, Glucose, Insulin