Current Diabetes Reports

, Volume 12, Issue 1, pp 101–107 | Cite as

Glycemic Targets and Approaches to Management of the Patient with Critical Illness

Hospital Management of Diabetes (M Korytkowski, Section Editor)

Abstract

Hyperglycemia during critical illness is associated with adverse outcome. The proof-of-concept Leuven studies assessed causality, and revealed that targeting strict normoglycemia (80–110 mg/dL) with insulin improved outcome compared with tolerating hyperglycemia to the renal threshold (215 mg/dL). A large multicenter trial (NICE-SUGAR [Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation]) found an intermediate blood glucose target (140–180 mg/dL) safer than targeting normoglycemia. Differences in design and in execution of glycemic control at the bedside may have contributed to these results. In NICE-SUGAR (Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation), the blood-glucose target range in the control group was lower, there were problems to reach and maintain normoglycemia in the intervention group, and inaccurate handheld blood glucose meters and variable blood sampling sites were allowed. Inaccurate tools led to insulin-dosing errors with consequently (undetected) hypoglycemia and unacceptable blood glucose variability. Also, the studies were done superimposed upon different nutritional strategies. Thus, such differences do not allow simple, evidence-based recommendations for daily practice, but an intermediate blood glucose target may be preferable while awaiting better tools to facilitate safely reaching normoglycemia.

Keywords

Hyperglycemia Critical illness Normoglycemia NICE-SUGAR Glycemic targets Stress hyperglycemia Blood glucose management 

Clinical Trial Acronyms

EPaNIC

Impact of Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients

Glucontrol

Comparing the Effects of Two Glucose Control Regimens by Insulin in Intensive Care Unit Patients

NICE-SUGAR

Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation

VISEP

Volume Substitution and Insulin Therapy in Severe Sepsis

Notes

Disclosure

No potential conflicts of interest relevant to this article were reported.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Laboratory and Department Intensive Care Medicine, Katholieke Universiteit LeuvenCatholic University of LeuvenLeuvenBelgium

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