title: Glucose control in the ICU: is there a time for more ambitious targets again?
abstract: During the last 2 decades, the treatment of hyperglycemia in critically ill patients has become one of the most discussed topics in the intensive medicine field. The initial data suggesting significant benefit of normalization of blood glucose levels in critically ill patients using intensive intravenous insulin therapy have been challenged or even neglected by some later studies. At the moment, the need for glucose control in critically ill patients is generally accepted yet the target glucose values are still the subject of ongoing debates. In this review, we summarize the current data on the benefits and risks of tight glucose control in critically ill patients focusing on the novel technological approaches including continuous glucose monitoring and its combination with computer-based algorithms that might help to overcome some of the hurdles of tight glucose control. Since increased risk of hypoglycemia appears to be the major obstacle of tight glucose control, we try to put forward novel approaches that may help to achieve optimal glucose control with low risk of hypoglycemia. If such approaches can be implemented in real-world practice the entire concept of tight glucose control may need to be revisited.
authors.affiliation: 3rd Department of Medicine, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic mhalu@lf1.cuni.cz.
authors.forename: Martin
authors.initials: M
authors.lastname: Haluzik
authors.affiliation: 3rd Department of Medicine, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic.
authors.forename: Milos
authors.initials: M
authors.lastname: Mraz
authors.affiliation: Department of Anaesthesia, Resuscitation and Intensive Medicine, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Kopecky
authors.affiliation: Department of Anaesthesia, Resuscitation and Intensive Medicine, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Lips
authors.affiliation: 3rd Department of Medicine, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic.
authors.forename: Stepan
authors.initials: S
authors.lastname: Svacina
mesh_terms: D000465:Algorithms; D001786:Blood Glucose; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007362:Intensive Care Units
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: continuous glucose monitoring; critically ill patients; glucose control; hypoglycemia; intensive care unit