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How low should you go? The limbo of glycemic control in intensive care units.
Crit Care Nurse. 2011 Aug; 31(4):e9-e18.CC

Abstract

Hyperglycemia, a common finding in critically ill patients, is linked to poor outcomes in multiple conditions. The Leuven I study published in 2001 was the first evaluation of intensive insulin therapy, and the 3.4% absolute reduction in mortality in a single-center surgical intensive care unit led to widespread endorsement of the therapy. In a subsequent study in a medical intensive care unit, reduction in mortality was not significant. Two multicenter studies were stopped early because of significantly higher rates of hypoglycemia in the patients receiving intensive insulin therapy. The episodes of hypoglycemia were linked to increased mortality. In the largest prospective study conducted to date, mortality was significantly higher (P = .02) in patients who had intensive therapy (27.5%) than in control patients (24.9%). Thus, after years of research, intensive insulin therapy does not appear to convey the original benefit in all critically ill patients. Several organizations have proposed alternative blood glucose targets, such as 140 to 180 mg/dL, to both provide glycemic control and reduce the opportunity for hypoglycemic episodes.

Authors+Show Affiliations

Methodist University Hospital, Dept of Pharmacy, Memphis, TN 38104, USA. rphfaust@gmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

21807674

Citation

Faust, Andrew C., et al. "How Low Should You Go? the Limbo of Glycemic Control in Intensive Care Units." Critical Care Nurse, vol. 31, no. 4, 2011, pp. e9-e18.
Faust AC, Attridge RL, Ryan L. How low should you go? The limbo of glycemic control in intensive care units. Crit Care Nurse. 2011;31(4):e9-e18.
Faust, A. C., Attridge, R. L., & Ryan, L. (2011). How low should you go? The limbo of glycemic control in intensive care units. Critical Care Nurse, 31(4), e9-e18. https://doi.org/10.4037/ccn2011188
Faust AC, Attridge RL, Ryan L. How Low Should You Go? the Limbo of Glycemic Control in Intensive Care Units. Crit Care Nurse. 2011;31(4):e9-e18. PubMed PMID: 21807674.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - How low should you go? The limbo of glycemic control in intensive care units. AU - Faust,Andrew C, AU - Attridge,Rebecca L, AU - Ryan,Laurajo, PY - 2011/8/3/entrez PY - 2011/8/3/pubmed PY - 2011/11/16/medline SP - e9 EP - e18 JF - Critical care nurse JO - Crit Care Nurse VL - 31 IS - 4 N2 - Hyperglycemia, a common finding in critically ill patients, is linked to poor outcomes in multiple conditions. The Leuven I study published in 2001 was the first evaluation of intensive insulin therapy, and the 3.4% absolute reduction in mortality in a single-center surgical intensive care unit led to widespread endorsement of the therapy. In a subsequent study in a medical intensive care unit, reduction in mortality was not significant. Two multicenter studies were stopped early because of significantly higher rates of hypoglycemia in the patients receiving intensive insulin therapy. The episodes of hypoglycemia were linked to increased mortality. In the largest prospective study conducted to date, mortality was significantly higher (P = .02) in patients who had intensive therapy (27.5%) than in control patients (24.9%). Thus, after years of research, intensive insulin therapy does not appear to convey the original benefit in all critically ill patients. Several organizations have proposed alternative blood glucose targets, such as 140 to 180 mg/dL, to both provide glycemic control and reduce the opportunity for hypoglycemic episodes. SN - 1940-8250 UR - https://www.unboundmedicine.com/medline/citation/21807674/How_low_should_you_go_The_limbo_of_glycemic_control_in_intensive_care_units_ L2 - https://aacnjournals.org/ccnonline/article-lookup/doi/10.4037/ccn2011188 DB - PRIME DP - Unbound Medicine ER -