Don't sugar coat it: Glycemic control in the intensive care unit Journal Article


Authors: Stoudt, K.; Chawla, S.
Article Title: Don't sugar coat it: Glycemic control in the intensive care unit
Abstract: Stress hyperglycemia is the transient increase in blood glucose as a result of complex hormonal changes that occur during critical illness. It has been described in the critically ill for nearly 200 years; patient harm, including increases in morbidity, mortality, and lengths of stay, has been associated with hyperglycemia, hypoglycemia, and glucose variability. However, there remains a contentious debate regarding the optimal glucose ranges for this population, most notably within the past 15 years. Recent landmark clinical trials have dramatically changed the treatment of stress hyperglycemia in the intensive care unit (ICU). Earlier studies suggested that tight glucose control improved both morbidity and mortality for ICU patients, but later studies have suggested potential harm related to the development of hypoglycemia. Multiple trials have tried to elucidate potential glucose target ranges for special patient populations, including those with diabetes, trauma, sepsis, cardiac surgery, and brain injuries, but there remains conflicting evidence for most of these subpopulations. Currently, most international organizations recommend targeting moderate blood glucose concentration to levels <180 mg/dL for all patients in the intensive care unit. In this review, the history of stress hyperglycemia and its treatment will be discussed including optimal glucose target ranges, devices for monitoring blood glucose, and current professional organizations’ recommendations regarding glucose control in the ICU. © The Author(s) 2018.
Keywords: review; c reactive protein; protein binding; hyperglycemia; intensive care unit; length of stay; severity of illness index; medical society; interleukin 6; glucose blood level; hypoglycemia; stress; glucose; cytokine release; tumor necrosis factor; artificial ventilation; critical illness; parenteral nutrition; sugar; hospital mortality; traumatic brain injury; clinical outcome; glucose utilization; nutritional support; acute coronary syndrome; glycemic control; gluconeogenesis; insulin treatment; renal replacement therapy; human; priority journal; blood glucose monitoring; all cause mortality; interactive ventilatory support
Journal Title: Journal of Intensive Care Medicine
Volume: 34
Issue: 11-12
ISSN: 0885-0666
Publisher: Sage Publications  
Date Published: 2019-11-01
Start Page: 889
End Page: 896
Language: English
DOI: 10.1177/0885066618801748
PROVIDER: scopus
PUBMED: 30309291
DOI/URL:
Notes: Review -- Export Date: 1 November 2019 -- Source: Scopus
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MSK Authors
  1. Sanjay Chawla
    19 Chawla
  2. Kara Christine Stoudt
    2 Stoudt