Diabetes and hyperglycemia: strict glycemic control.
OBJECTIVE
To critically review recent evidence on pathophysiology, diagnosis, and control of acute and chronic hyperglycemia in medical and surgical intensive care unit (ICU) patients.


METHODS
A MEDLINE/PubMed search (1966 through February 2006) with manual cross-referencing was conducted, including all relevant articles published on blood glucose control in intensive care patients. An emphasis was placed on more recent clinical trials investigating the effects of tight glycemic control in ICU patients and on basic science studies investigating the pathophysiology and systemic effects of transient hyperglycemia in nondiabetic patients.


METHODS
Original articles, selected reviews, letters to the editor, and chapters of selected textbooks were extracted. The reviewed information was then analyzed with respect to the prevalence of hyperglycemia in ICU patients, the pathophysiology of hyperglycemia in nondiabetics, and evidence on glycemic control in various subgroups of ICU patients. The risk of iatrogenic hypoglycemia in the ICU and potential future research directions are discussed at the end of the review.


CONCLUSIONS
Recent evidence shows direct improvements in patient mortality and in-hospital morbidity with strict control of even short-term elevations of glucose levels in certain subgroups of ICU patients. However, precisely defined target glucose levels, subgroup analyses of different patient populations and treatment interventions, and the avoidance of hypoglycemic episodes during insulin therapy remain incompletely resolved and warrant future investigation.
Turina
Matthias
M
Department of Surgery, Price Institute of Surgical Research, University of Louisville School of Medicine, Louisville, KY, USA.
Christ-Crain
Mirjam
M
Polk
Hiram C
HC
D001786:Blood Glucose / Q000032:analysis; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007362:Intensive Care Units
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin