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World J Crit Care Med. Feb 4, 2012; 1(1): 31-39
Published online Feb 4, 2012. doi: 10.5492/wjccm.v1.i1.31
Glycemic control in critically ill patients
Chien-Wei Hsu
Chien-Wei Hsu, Department of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan, China
Chien-Wei Hsu, Intensive Care Unit, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan, China
Author contributions: Hsu CW solely contributed to this paper.
Correspondence to: Chien-Wei Hsu, MD, Assistant Professor, Attending Physician, Intensive Care Unit, Department of Medicine, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan, China.
Telephone: +886-7342121-2081 Fax: +886-73420243
Received: June 24, 2011
Revised: November 10, 2011
Accepted: December 21, 2011
Published online: February 4, 2012

Hyperglycemia is common in critically ill patients and can be caused by various mechanisms, including nutrition, medications, and insufficient insulin. In the past, hyperglycemia was thought to be an adaptive response to stress, but hyperglycemia is no longer considered a benign condition in patients with critical illnesses. Indeed, hyperglycemia can increase morbidity and mortality in critically ill patients. Correction of hyperglycemia may improve clinical outcomes. To date, a definite answer with regard to glucose management in general intensive care unit patients, including treatment thresholds and glucose target is undetermined. Meta-analyses of randomized controlled trials suggested no survival benefit of tight glycemic control and a significantly increased incidence of hypoglycemia. Studies have shown a J- or U-shaped relationship between average glucose values and mortality; maintaining glucose levels between 100 and 150 mg/dL was likely to be associated with the lowest mortality rates. Recent studies have shown glycemic control < 180 mg/dL is not inferior to near-normal glycemia in critically ill patients and is clearly safer. Glycemic variability is also an important aspect of glucose management in the critically ill patients. Higher glycemic variability may increase the mortality rate, even in patients with the same mean glucose level. Decreasing glucose variability is an important issue for glycemic control in critically ill patients. Continuous measurements with automatic closed-loop systems could be considered to ensure that blood glucose levels are controlled within a specific range and with minimal variability.

Keywords: Critical care, Glycemic control, Hyperglycemia, Hypoglycemia, Insulin