title: Clinical experience with tight glucose control by intensive insulin therapy.
abstract: OBJECTIVE
  To describe the current status and the clinical data related to the effects of tight glucose control by intensive insulin therapy in critically ill patients.
  
  
  METHODS
  Review article.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Medical and surgical critically ill patients in whom a correlation between blood glucose and outcome variables were searched.
  
  
  METHODS
  Tight glucose control by intensive insulin therapy.
  
  
  RESULTS
  In contrast to the decreases in mortality and to low severity of adverse effects reported when insulin rate was titrated to keep blood glucose between 80 and 110 mg/dL, the benefits were not confirmed in multicenter prospective studies. Retrospective data found an association between a mean blood glucose level of <140-150 mg/dL and improved outcome. Currently unanswered issues include the optimal target for blood glucose, the effects of high blood glucose variability, the risks and hazards of hypoglycemia, and the potential influence of the underlying disorder on the effects of tight glucose control.
  
  
  CONCLUSIONS
  Recommendations regarding the practical aspects of tight glucose control by intensive insulin therapy cannot be presently issued. An intermediate target level for blood glucose of 140-180 mg/dL seems to be associated with the lowest risk-to-benefit ratio.
authors: Department of General Intensive Care, University Hospital Center, University of Liege, Domaine universitaire du Sart-Tilman, Liege, Belgium. Jean-Charles.Preiser@chu.ulg.ac.be
authors: Jean-Charles
authors: JC
authors: Preiser
authors: Philippe
authors: P
authors: Devos
mesh_terms: D001786:Blood Glucose; D016638:Critical Illness; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin