[Stress hyperglycemia and its control with insulin in critically ill patients: current evidence].
OBJECTIVE
To analyze the current evidence on glycemic control with insulin therapy in the critically ill.


RESULTS
Stress hyperglycemia in critically ill patients has been associated with increased morbidity and mortality. Furthermore, current evidence suggests that glucose variability has a predictive value for hospital mortality. Initially, the Leuven studies showed that intensive insulin therapy was capable of reducing the mortality among surgical and medical ICU patients. Nevertheless, this strategy significantly increases the incidence of severe hypoglycemia. Three important trials on glucose control have been published recently: the VISEP, the Glucontrol study and the NICE-SUGAR. They have shown that strict control of glycemia is associated with a higher incidence of mortality and severe hypoglycemia. Furthermore, according to a recent meta-analysis, intensive insulin therapy may be beneficial for patients admitted to a surgical ICU. Further studies should be able to address some queries about these results on glycemic control in the critically ill.
Manzanares
W
W
Cátedra de Medicina Intensiva, Centro de Tratamiento Intensivo, Hospital de Clínicas, Facultad de Medicina-UDELAR, Montevideo, Uruguay. wmanzanares@adinet.com.uy
Aramendi
I
I
D001786:Blood Glucose / Q000032:analysis; D016638:Critical Illness; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin