Emerging paradigms on glucose management in the intensive care unit

• Published in: Minerva endocrinologica Vol. 39; no. 4; p. 261
• Main Authors: Evans, A S, Hosseinian, L, Mechanick, J I
• Format: Journal Article
• Language: English
• Published: Italy 01-12-2014
• Subjects: Adaptation, Physiological; Blood Glucose - analysis; Clinical Protocols; Critical Care - economics; Critical Care - methods; Critical Illness; Diabetes Complications - blood; Diabetes Complications - physiopathology; Disease Management; Dyslipidemias - drug therapy; Dyslipidemias - etiology; Humans; Hyperglycemia - drug therapy; Hyperglycemia - economics; Hyperglycemia - etiology; Hyperglycemia - physiopathology; Hyperglycemia - prevention & control; Hypoglycemia - etiology; Hypoglycemia - prevention & control; Insulin - adverse effects; Insulin - pharmacology; Insulin - therapeutic use; Intensive Care Units; Medicare - economics; Multicenter Studies as Topic; Nutritional Support; Oxidative Stress - drug effects; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Stress, Physiological - physiology; United States; United States
• ISSN: 0391-1977

Hyperglycemia is common in critical illness and leads to increased morbidity and mortality. Controversy exists whether tight glycemic control via intensive insulin therapy can safely and effectively improve outcomes. In this review article, we will sort through the pertinent evidence base to identify salient, yet emergent, paradigms to guide management. To this end, we will discuss underlying biologic mechanisms relevant to hyperglycemia and insulinization in critical illness, summarize results of major randomized controlled clinical trials for glycemic control in the intensive care unit (ICU), and fill in the gaps with necessary information. We will conclude with specific messages, not only reflecting our own clinical experiences, but amenable to implementation in different ICU settings.