title: [Glucose variability in intensive care unit].
abstract: Hyperglycemia is significantly associated with increased mortality in critically ill patients and then, strict control of blood glucose (BG) concentration is important. Lowering of BG levels with intensive insulin therapy (IIT) was recommended in order to improve patient outcomes. But recently, some recent prospective trials failed to confirm the initial data, showing conflicting results (significantly increased mortality with IIT, more hypoglycemic episodes). So there is no consensus about efficiency and safety of IIT. Significant associations between glucose variability and mortality have been confirmed by several recent studies. A difference in variability of BG control could explain why the effect of IIT varied from beneficial to harmful. Managing and decreasing this BG variability could be an important goal of BG control in critically ill patients. Clinicians have to consider definitions, physiopathology and impacts of glucose variability, in order to improve patient outcomes.
authors.affiliation: Département d'anesthésie-réanimation, hôpital d'Instruction des Armées Val-de-Grâce, 74 boulevard de Port-Royal, Paris, France.
authors.forename: J-V
authors.initials: JV
authors.lastname: Schaal
authors.forename: N
authors.initials: N
authors.lastname: Libert
authors.forename: S
authors.initials: S
authors.lastname: De Rudnicki
authors.forename: Y
authors.initials: Y
authors.lastname: Auroy
authors.forename: S
authors.initials: S
authors.lastname: Mérat
mesh_terms: D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D003422:Critical Care; D016638:Critical Illness; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000628:therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007362:Intensive Care Units; D008991:Monitoring, Physiologic
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin