title: International recommendations for glucose control in adult non diabetic critically ill patients.
abstract: BACKGROUND
  The purpose of this research is to provide recommendations for the management of glycemic control in critically ill patients.
  
  
  METHODS
  Twenty-one experts issued recommendations related to one of the five pre-defined categories (glucose target, hypoglycemia, carbohydrate intake, monitoring of glycemia, algorithms and protocols), that were scored on a scale to obtain a strong or weak agreement. The GRADE (Grade of Recommendation, Assessment, Development and Evaluation) system was used, with a strong recommendation indicating a clear advantage for an intervention and a weak recommendation indicating that the balance between desirable and undesirable effects of an intervention is not clearly defined.
  
  
  RESULTS
  A glucose target of less than 10 mmol/L is strongly suggested, using intravenous insulin following a standard protocol, when spontaneous food intake is not possible. Definition of the severe hypoglycemia threshold of 2.2 mmol/L is recommended, regardless of the clinical signs. A general, unique amount of glucose (enteral/parenteral) to administer for any patient cannot be suggested. Glucose measurements should be performed on arterial rather than venous or capillary samples, using central lab or blood gas analysers rather than point-of-care glucose readers.
  
  
  CONCLUSIONS
  Thirty recommendations were obtained with a strong (21) and a weak (9) agreement. Among them, only 15 were graded with a high level of quality of evidence, underlying the necessity to continue clinical studies in order to improve the risk-to-benefit ratio of glucose control.
authors.affiliation: Medical and Surgical Intensive Care Unit, Saint-Roch Hospital, University of Medicine of Nice, 06000 Nice, France. ichai@unice.fr
authors.forename: Carole
authors.initials: C
authors.lastname: Ichai
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Preiser
mesh_terms: D000328:Adult; D000367:Age Factors; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D003422:Critical Care / Q000379:methods / Q000592:standards*; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy*; D005947:Glucose / Q000378:metabolism; D038321:Glycemic Index / Q000187:drug effects / Q000502:physiology*; D006287:Health Planning Guidelines; D006801:Humans; D007328:Insulin / Q000494:pharmacology / Q000627:therapeutic use; D038622:Internationality
chemical_list: D001786:Blood Glucose; D007328:Insulin; D005947:Glucose