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Blood glucose control in the intensive care unit: benefits and risks.
Semin Dial. 2010 Mar-Apr; 23(2):157-62.SD

Abstract

Abnormal blood glucose levels are common during critical illness and are associated with outcomes that correspond to a J-shaped curve, the lowest risk associated with normoglycemia. Three proof-of-concept randomized-controlled-trials performed in the surgical, medical, and pediatric intensive care units of the Leuven University Hospital in Belgium demonstrated that maintaining strict age-adjusted normal fasting levels of glycemia (80-110 mg/dl in adults, 70-100 mg/dl in children, 50-80 mg/dl in infants) with intensive insulin therapy reduced morbidity and mortality as compared with tolerating stress hyperglycemia as a potentially beneficial response. Recently, concern has risen about the safety of this intervention, as a multicenter adult study reported an, as yet unexplained, increased mortality with targeting normoglycemia as compared with an intermediate blood glucose level of around 140 mg/dl. This apparent contradiction may be explained by several methodological differences among studies, comprising, among others, different glucose target ranges in the control groups, different feeding policies, and variable accuracy of tools used for glucose measurement and insulin infusion. Hence, efficacy and safety of intensive insulin therapy may be affected by patient-related and ICU setting-related variables. Therefore, no single optimal blood glucose target range for ICU patients can be advocated. It appears safe not to embark on targeting "age-normal" levels in intensive care units (ICUs) that are not equipped to accurately and frequently measure blood glucose, and have not acquired extensive experience with intravenous insulin administration using a customized guideline. A simple fallback position could be to control blood glucose levels as close to normal as possible without evoking unacceptable blood glucose fluctuations, hypoglycemia, and hypokalemia.

Authors+Show Affiliations

Department and Laboratory of Intensive Care Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

20525106

Citation

Gunst, Jan, and Greet Van den Berghe. "Blood Glucose Control in the Intensive Care Unit: Benefits and Risks." Seminars in Dialysis, vol. 23, no. 2, 2010, pp. 157-62.
Gunst J, Van den Berghe G. Blood glucose control in the intensive care unit: benefits and risks. Semin Dial. 2010;23(2):157-62.
Gunst, J., & Van den Berghe, G. (2010). Blood glucose control in the intensive care unit: benefits and risks. Seminars in Dialysis, 23(2), 157-62. https://doi.org/10.1111/j.1525-139X.2010.00702.x
Gunst J, Van den Berghe G. Blood Glucose Control in the Intensive Care Unit: Benefits and Risks. Semin Dial. 2010 Mar-Apr;23(2):157-62. PubMed PMID: 20525106.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Blood glucose control in the intensive care unit: benefits and risks. AU - Gunst,Jan, AU - Van den Berghe,Greet, PY - 2010/6/8/entrez PY - 2010/6/9/pubmed PY - 2010/9/30/medline SP - 157 EP - 62 JF - Seminars in dialysis JO - Semin Dial VL - 23 IS - 2 N2 - Abnormal blood glucose levels are common during critical illness and are associated with outcomes that correspond to a J-shaped curve, the lowest risk associated with normoglycemia. Three proof-of-concept randomized-controlled-trials performed in the surgical, medical, and pediatric intensive care units of the Leuven University Hospital in Belgium demonstrated that maintaining strict age-adjusted normal fasting levels of glycemia (80-110 mg/dl in adults, 70-100 mg/dl in children, 50-80 mg/dl in infants) with intensive insulin therapy reduced morbidity and mortality as compared with tolerating stress hyperglycemia as a potentially beneficial response. Recently, concern has risen about the safety of this intervention, as a multicenter adult study reported an, as yet unexplained, increased mortality with targeting normoglycemia as compared with an intermediate blood glucose level of around 140 mg/dl. This apparent contradiction may be explained by several methodological differences among studies, comprising, among others, different glucose target ranges in the control groups, different feeding policies, and variable accuracy of tools used for glucose measurement and insulin infusion. Hence, efficacy and safety of intensive insulin therapy may be affected by patient-related and ICU setting-related variables. Therefore, no single optimal blood glucose target range for ICU patients can be advocated. It appears safe not to embark on targeting "age-normal" levels in intensive care units (ICUs) that are not equipped to accurately and frequently measure blood glucose, and have not acquired extensive experience with intravenous insulin administration using a customized guideline. A simple fallback position could be to control blood glucose levels as close to normal as possible without evoking unacceptable blood glucose fluctuations, hypoglycemia, and hypokalemia. SN - 1525-139X UR - https://www.unboundmedicine.com/medline/citation/20525106/Blood_glucose_control_in_the_intensive_care_unit:_benefits_and_risks_ L2 - https://doi.org/10.1111/j.1525-139X.2010.00702.x DB - PRIME DP - Unbound Medicine ER -