title: The impact of premorbid diabetic status on the relationship between the three domains of glycemic control and mortality in critically ill patients.
abstract: OBJECTIVE
  Hyperglycemia, hypoglycemia and increased glycemic variability are independently associated with increased risk of mortality in critically ill patients. The purpose of this review is to evaluate the evidence from interventional trials of intensive insulin therapy, as well as observational cohort studies, relating premorbid diabetic status and these three domains of glycemic control to mortality.
  
  
  RESULTS
  Hyperglycemia has a stronger association with mortality in critically ill patients without diabetes than in those with diabetes. Hypoglycemia is independently associated with increased risk of mortality in both populations. Limited data suggest that increased glycemic variability may have a stronger association with mortality in patients without diabetes than in those with diabetes.
  
  
  CONCLUSIONS
  Premorbid diabetic status impacts the relationship of the three domains of glycemic control to risk of mortality in critically ill patients. The data presented in this review are hypothesis generating; future trials of IIT in the critically ill should stratify management and outcomes by premorbid diabetic status.
authors.affiliation: Division of Critical Care, Stamford Hospital, Columbia University College of Physicians and Surgeons, Stamford, Connecticut 06902, USA. jkrinsley@stamhealth.org
authors.forename: James S
authors.initials: JS
authors.lastname: Krinsley
authors.forename: Geert
authors.initials: G
authors.lastname: Meyfroidt
authors.forename: Greet
authors.initials: G
authors.lastname: van den Berghe
authors.forename: Mori
authors.initials: M
authors.lastname: Egi
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000401:mortality*; D038321:Glycemic Index; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D007003:Hypoglycemia / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D007328:Insulin / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
chemical_list: D001786:Blood Glucose; D007328:Insulin