Clinical experience with tight glucose control by intensive insulin therapy.
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.
Preiser
Jean-Charles
JC
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
Devos
Philippe
P
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*
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin