Should guidelines for glycemic control of the critically ill be individualized?: Weighing the evidence from randomized and observational investigations.
The monitoring of blood glucose and treatment of hyperglycemia has been a standard of care in intensive care units since the publication of a single-center randomized controlled trial (RCT) of intensive insulin therapy in 2001 that demonstrated marked improvements in mortality. Professional societies created guidelines based on the results of this investigation, and revised them based on the results of a very small group of RCTs that followed. This commentary reviews the weight of evidence provided by the RCTs in comparison to the large body of evidence from observational studies regarding glycemic control of the critically ill, and suggests that the totality of evidence should be considered in the formulation of clinical practice paradigms.
Director of Critical Care, Stamford Hospital, Stamford, CT; Clinical Professor of Medicine, Columbia University College of Physicians and Surgeons, New York, NY. jkrinsley@stamhealth.org.
James S
JS
Krinsley
D001786:Blood Glucose; D016638:Critical Illness; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units / Q000458:organization & administration; D008991:Monitoring, Physiologic; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin