title: Special considerations for the diabetic patient in the ICU; targets for treatment and risks of hypoglycaemia.
abstract: Due to the diabetes pandemic the number of diabetic patients admitted to the intensive care unit (ICU) increases. Diabetic patients admitted to the ICU are more vulnerable for developing complications as compared to non-diabetic patients, but this does not directly translate into higher mortality rates. However, mortality might differ per admission diagnosis. Hyperglycaemia is common in diabetic as well as non-diabetic critically ill patients, but probably chronic hyperglycaemia is pathophysiologically different from acute hyperglycaemia. As opposed to non-diabetic patients, there is discussion about the association between hyperglycaemia and mortality in diabetic patients. They do not seem to benefit from strict glycaemic control and also glucose variability appears less harmful, although clinical trials in diabetic populations have not been performed yet. Diabetes is a risk factor for hypoglycaemia and evidence suggests that even near-normal glucose levels are associated with worse outcome. Taking this together, it is suggested to strive for moderate targets when treating hyperglycaemia in critically ill diabetic patients.
authors.affiliation: Department of Internal Medicine, Academic Medical Centre, Meibergdreef 9, Room F4-257, 1105 AZ Amsterdam, The Netherlands. s.e.siegelaar@amc.uva.nl
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Siegelaar
authors.forename: Joost B L
authors.initials: JB
authors.lastname: Hoekstra
authors.forename: J Hans
authors.initials: JH
authors.lastname: DeVries
mesh_terms: D003422:Critical Care / Q000639:trends*; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016903:Drug Monitoring; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000453:epidemiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D007362:Intensive Care Units; D017410:Practice Guidelines as Topic; D012307:Risk Factors
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin