Diabetes and hyperglycemia: strict glycemic control.

Area of Science:

• Critical care medicine
• Endocrinology
• Metabolic disorders

Background:

• Hyperglycemia is common in intensive care unit (ICU) patients, affecting both diabetic and non-diabetic individuals.
• Transient hyperglycemia can have significant systemic effects, contributing to morbidity and mortality.
• Understanding the pathophysiology of hyperglycemia in critically ill patients is crucial for effective management.

Purpose of the Study:

• To review current evidence on the pathophysiology, diagnosis, and management of hyperglycemia in ICU patients.
• To evaluate the impact of glycemic control strategies on patient outcomes.
• To identify gaps in knowledge and future research directions.

Main Methods:

• Comprehensive literature search of MEDLINE/PubMed (1966-2006) and manual cross-referencing.
• Inclusion of original articles, reviews, letters, and textbook chapters focusing on critical care glycemic control.
• Analysis of data regarding hyperglycemia prevalence, pathophysiology, and treatment efficacy in various ICU subgroups.

Main Results:

• Strict control of hyperglycemia, even short-term elevations, is associated with improved mortality and reduced in-hospital morbidity in specific ICU patient groups.
• Evidence supports the benefits of tight glycemic control in certain critically ill populations.
• The risk of iatrogenic hypoglycemia associated with intensive insulin therapy is a significant concern.

Conclusions:

• Recent evidence demonstrates that strict glucose control in ICUs can lead to better patient outcomes.
• Further research is required to establish optimal target glucose levels and refine treatment interventions for diverse ICU populations.
• Minimizing hypoglycemia during insulin therapy remains a critical challenge requiring further investigation.