title: Are closed-loop systems for intensive insulin therapy ready for prime time in the ICU?
abstract: OBJECTIVE
  Recent findings suggest that the effects of tight glycemic control (TGC) performing intensive insulin therapy (IIT) in medical and surgical ICU have had conflicting results. The purpose of this review is to summarize the current evidence in humans how closed-loop systems for IIT are ready for prime time in the ICU.
  
  
  RESULTS
  Current evidence suggests that maintaining normoglycemia postoperatively can improve the outcome and reduce the mortality and morbidity of critically ill patients by TGC performing IIT according to the large randomized trials. However, trials examining the effects of TGC have had conflicting results. Systematic reviews and meta-analyses have also led to differing conclusions. The main reason these clinical trials and meta-analyses were negative results for TGC was because of the high incidence of hypoglycemia. This could not be prevented as there is no reliable technique currently able to avoid this condition during IIT. The development of accurate, continuous blood glucose monitoring devices, and closed-loop systems for computer-assisted blood glucose control in the ICU, will probably help avoid hypoglycemia in these situations.
  
  
  CONCLUSIONS
  The challenge in the hospital setting demonstrated that a closed-loop glycemic control system is expected to the achievement of TGC with no occurrence of hypoglycemia induced by IIT after surgery. Closed-loop glycemic control systems for IIT are now ready for prime time in the ICU.
authors.affiliation: Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi City, Kochi, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Okabayashi
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Shima
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007362:Intensive Care Units; D011182:Postoperative Care
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin