Advertisement

Intensive Care Medicine

, Volume 42, Issue 9, pp 1482–1484 | Cite as

Glycemic control: please agree to disagree

  • Jean-Charles PreiserEmail author
  • Heleen M. Oudemans-van Straaten
What's New in Intensive Care

Introduction

Real science depends for its progress on continual challenges to the current state of always-imperfect knowledge.

D. Sarewitz, Nature 2011;478:7.

Two dissenting views on glycemic control during critical illness were recently published in Intensive Care Medicine. The first interpretation by Marik [1] recommends a “no-touch” approach based on the adaptive and physiological properties of stress hyperglycemia, which provides a benefit that largely outweighs the risks of absolute or relative hypoglycemia associated with intensive insulin therapy. The second interpretation by Gunst and Van den Berghe [2] strongly advocates tight glycemic control by intensive insulin therapy (IIT) on the basis of the prevention of the toxicity of prolonged hyperglycemia, and on the favorable risk-to-benefit ratio reported in the pioneering clinical studies performed in Leuven [3, 4, 5].

These apparently irreconcilable viewpoints on the same set of data highlight the current status of our...

Keywords

Hypoglycemia Glycemic Control Critical Illness Target Range Intensive Insulin Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest

References

  1. 1.
    Marik P (2016) Tight glycemic control in acutely ill patients: low evidence of benefit, high evidence of harm! Intensive Care Med. doi: 10.1007/s00134-016-4299-2 Google Scholar
  2. 2.
    Gunst J, Van den Berghe G (2016) Blood glucose control in the ICU: don’t throw out the baby with the bathwater! Intensive Care Med. doi: 10.1007/s00134-016-4350-3 PubMedGoogle Scholar
  3. 3.
    Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M et al (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 2001(345):1359–1367CrossRefGoogle Scholar
  4. 4.
    Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I et al (2006) Intensive insulin therapy in the medical ICU (2006). N Engl J Med 354:449–461CrossRefPubMedGoogle Scholar
  5. 5.
    Vlasselaers D, Milants I, Desmet L, Wouters PJ, Vanhorebeek I, van den Heuvel I et al (2009) Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet 373:547–556CrossRefPubMedGoogle Scholar
  6. 6.
    Hermanides J, Vriesendorp TM, Bosman RJ, Zandstra DF, Hoekstra JB, Devries JH (2010) Glucose variability is associated with intensive care unit mortality. Crit Care Med 38:838–842CrossRefPubMedGoogle Scholar
  7. 7.
    Siegelaar SE, Hermanides J, Oudemans-van Straaten HM, van der Voort PH, Bosman RJ, Zandstra DF et al (2010) Mean glucose during ICU admission is related to mortality by a U-shaped curve in surgical and medical patients: a retrospective cohort study. Crit Care 14:R224CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Badawi O, Waite MD, Fuhrman SA, Zuckerman IH (2012) Association between intensive care unit-acquired dysglycemia and in-hospital mortality. Crit Care Med 2012(40):3180–3188CrossRefGoogle Scholar
  9. 9.
    Krinsley JS, Egi M, Kiss A, Devendra AN, Schuetz P, Maurer PM et al (2013) Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: an international multicenter cohort study. Crit Care 17:R37CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, Blair D, Foster D et al (2009) Intensive versus conventional glucose control in critically ill patients. N Engl J Med 360:1346–1349CrossRefGoogle Scholar
  11. 11.
    Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G et al (2011) Early versus late parenteral nutrition in critically ill adults. N Engl J Med 365:506–517CrossRefPubMedGoogle Scholar
  12. 12.
    Sechterberger MK, Bosman RJ, Oudemans-van Straaten HM, Siegelaar SE, Hermanides J, Hoekstra JB et al (2013) The effect of diabetes mellitus on the association between measures of glycaemic control and ICU mortality: a retrospective cohort study. Crit Care 17:R52CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Schultz MJ, Harmsen RE, Spronk PE (2010) Clinical review: strict or loose glycemic control in critically ill patients—implementing best available evidence from randomized controlled trials. Crit Care 14:R223CrossRefGoogle Scholar
  14. 14.
    van Hooijdonk RT, Binnekade JM, Bos LD, Horn J, Juffermans NP, Abu-Hanna A et al (2015) Associations between bolus infusion of hydrocortisone, glycemic variability and insulin infusion rate variability in critically ill patients under moderate glycemic control. Ann Intensive Care 5:34CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Wernerman J, Desaive T, Finfer S, Foubert L, Furnary A, Holzinger U et al (2014) Continuous glucose control in the ICU: report of a 2013 round table meeting. Crit Care 18:226CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Jean-Charles Preiser
    • 1
    Email author
  • Heleen M. Oudemans-van Straaten
    • 2
  1. 1.Department of Intensive Care, Erasme University HospitalUniversité Libre de BruxellesBrusselsBelgium
  2. 2.Department of Adult Intensive CareVU University Medical CentreAmsterdamThe Netherlands

Personalised recommendations