Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Aug 10, 2015; 6(9): 1082-1091
Published online Aug 10, 2015. doi: 10.4239/wjd.v6.i9.1082
Glucose control in critical care
Jeremy Clain, Kannan Ramar, Salim R Surani
Jeremy Clain, College of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
Kannan Ramar, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
Salim R Surani, Division of Pulmonary, Critical Care and Sleep Medicine, Texas AM University, Aransas Pass, TX 78336, United States
Author contributions: Clain J, Ramar K and Surani SR contributed to this paper.
Conflict-of-interest statement: None of the authors have any conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Salim R Surani, MD, MPH, MSHM, FACP, FCCP, Associate Professor, Division of Pulmonary, Critical Care and Sleep Medicine, Texas AM University, 1177 West Wheeler Ave, Suite 1, Aransas Pass, TX 78336, United States. srsurani@hotmail.com
Telephone: +1-361-8857722 Fax: +1-361-8507563
Received: January 29, 2015
Peer-review started: February 2, 2015
First decision: June 18, 2015
Revised: July 14, 2015
Accepted: July 29, 2015
Article in press: August 3, 2015
Published online: August 10, 2015
Processing time: 197 Days and 6.6 Hours
Abstract

Glycemic control among critically-ill patients has been a topic of considerable attention for the past 15 years. An initial focus on the potentially deleterious effects of hyperglycemia led to a series of investigations regarding intensive insulin therapy strategies that targeted tight glycemic control. As knowledge accumulated, the pursuit of tight glycemic control among critically-ill patients came to be seen as counterproductive, and moderate glycemic control came to dominate as the standard practice in intensive care units. In recent years, there has been increased focus on the importance of hypoglycemic episodes, glycemic variability, and premorbid diabetic status as factors that contribute to outcomes among critically-ill patients. This review provides a survey of key studies on glucose control in critical care, and aims to deliver perspective regarding glycemic management among critically-ill patients.

Keywords: Glycemic control; Critical care; Blood sugar in intensive care unit; Diabetes in intensive care unit; Glycemic control

Core tip: Glucose control among critically-ill patients has been an area of active research and considerable controversy in the past 15 years. This review provides a practical guide to the evidence, with a survey of the key studies that have informed current perspectives and clinical guidelines related to glycemic management among the critically ill. The article shows why initial enthusiasm for tight glycemic control waned as evidence accumulated favoring more modest glucose goals. The article also summarizes recent work investigating the importance of hypoglycemic episodes, glycemic variability, and premorbid diabetic status on morbidity and mortality in the intensive care unit.