Glucose control in the ICU
Open accessAbstract
PURPOSE OF REVIEW: Critically ill patients usually develop hyperglycemia, which is associated with adverse outcome. Controversy exists whether the relationship is causal or not. This review summarizes recent evidence regarding glucose control in the ICU. RECENT FINDINGS: Despite promising effects of tight glucose control in pioneer randomized controlled trials, the benefit has not been confirmed in subsequent multicenter studies and one trial found potential harm. This discrepancy could be explained by methodological differences between the trials rather than by a different case mix. Strategies to improve the efficacy and safety of tight glucose control have been developed, including the use of computerized treatment algorithms. SUMMARY: The ideal blood glucose target remains unclear and may depend on the context. As compared with tolerating severe hyperglycemia, tight glucose control is well tolerated and effective in patients receiving early parenteral nutrition when provided with a protocol that includes frequent, accurate glucose measurements and avoids large glucose fluctuations. All patient subgroups potentially benefit, with the possible exception of patients with poorly controlled diabetes, who may need less aggressive glucose control. It remains unclear whether tight glucose control is beneficial or not in the absence of early parenteral nutrition.
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Tight glucose control is feasible in patients receiving parenteral nutrition if a strict protocol is followed.
“Tight glucose control is feasible in patients receiving parenteral nutrition if a strict protocol is followed [29].”
From Nutrition in Sepsis: A Bench-to-Bedside Review. (2020) · cites this paper as [29]
The Conclusion states that tight glucose control is safe and effective in patients receiving early parenteral nutrition when accurate monitoring and a reliable insulin protocol are provided. That supports feasibility under those conditions, but the citing sentence omits the early-feeding and accurate-monitoring qualifications. (LLM, conf=0.85)
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Management of diabetes and hyperglycaemia in the hospital
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- Authors
- Gunst, J., De Bruyn, A., & Van den Berghe, G.
- Affiliations
- KU Leuven (BE)
- ORCID
- Gunst, Jan
- Venue
- Current Opinion in Anaesthesiology
- Published
- 2019-04
- Volume
- 32
- Issue
- 2
- Pages
- 156-162
- ISSN
- 0952-7907 (ISSN-L)
- PMC
- PMC6774765
- OpenAlex
- W2911949585
- Cited by
- 84
- References
- 53
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 9 · 2023: 14 · 2022: 17 · 2021: 14 · 2020: 16 · 2019: 4
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Current Opinion in Anaesthesiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Lirias (submittedVersion, other-oa)
- Funders
- Fonds Wetenschappelijk Onderzoek (T003617N, C24/17/070)
- Vlaamse regering (METH/14/06)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- tight glycemic control, hyperglycemia, critically ill patients, intensive care unit, glycemic targets, early parenteral nutrition, glucose fluctuations, diabetes mellitus, adverse outcomes
- MeSH terms
- Blood Glucose, Critical Care, Humans, Hyperglycemia, Hypoglycemic Agents, Intensive Care Units, Severity of Illness Index, Randomized Controlled Trials as Topic, Critical Illness, Treatment Outcome, Critical Pathways
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