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Glucose Control in the Intensive Care Unit

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Obesity and Diabetes

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Abstract

Most critically ill patients develop hyperglycemia, the degree of which is associated with mortality. However, randomized controlled trials investigating tight glucose control have found a divergent impact on morbidity and mortality, possibly explained by differences in glucose targets, monitoring and titration tools, and nutritional strategies. In patients receiving parenteral nutrition early in the course of critical illness, tight glucose control has shown to be effective and safe when performed with a validated protocol, including accurate glucose measurements. The optimal blood glucose target remains unclear for patients not receiving early parenteral nutrition, and may differ according to the premorbid diabetes status. Efficacy and safety of tight glucose control can be improved by using validated decision-support software, continuous glucose monitoring and closed-loop insulin delivery, although widespread implementation of these technologies is precluded by the ongoing controversy on the topic, the added cost, and, for some devices, lack of measurement accuracy.

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Acknowledgments

JG and GVdB receive a research grant from the Research Foundation—Flanders (FWO; T003617N). JG receives a research grant from the University of Leuven (C24/17/070) and a postdoctoral research fellowship supported by the Clinical Research and Education Council of the University Hospitals Leuven. GVdB receives structural research financing via the Methusalem program funded by the Flemish government through the university of Leuven (METH14/06) and a European Research Council Advanced Grant (ERC-2017-ADG-785809).

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Authors and Affiliations

  1. Department of Cellular and Molecular Medicine, Clinical Division and Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium

    Jan Gunst & Greet Van den Berghe

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  1. Jan Gunst
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  2. Greet Van den Berghe
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Correspondence to Greet Van den Berghe .

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Editors and Affiliations

  1. Hospital das Clinicas, Sao Paulo University Medical School, Sao Paulo, Brazil

    Joel Faintuch

  2. Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Salomão Faintuch

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Gunst, J., Van den Berghe, G. (2020). Glucose Control in the Intensive Care Unit. In: Faintuch, J., Faintuch, S. (eds) Obesity and Diabetes. Springer, Cham. https://doi.org/10.1007/978-3-030-53370-0_42

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