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Published on: June 11, 2012
Hypoglycemia and strict glycemic control in critically ill patients
Titia M Vriesendorp1, J Hans DeVries, Joost B L Hoekstra
1Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands. t.m.vriesendorp@amc.uva.nl
Current Opinion in Critical Care
|July 11, 2008
Summary
Hypoglycemia in critically ill patients is more frequent with strict glycemic control but its benefits likely outweigh risks. Avoid hypoglycemia without compromising glycemic control, using algorithms and surveillance for high-risk patients.
Area of Science:
- Critical Care Medicine
- Endocrinology
Background:
- Data on hypoglycemia in critically ill patients are limited compared to those with diabetes mellitus.
- Strict glycemic control has shown benefits in critically ill patients, but recent studies raise concerns about hypoglycemia.
- Hypoglycemia is more frequent (4-7 times) in patients undergoing strict glycemic control.
Purpose of the Study:
- To review the prevalence, risk factors, and consequences of hypoglycemia in critically ill patients.
- To synthesize current evidence on the balance between glycemic control benefits and hypoglycemia risks.
Main Methods:
- Literature review of available data on hypoglycemia in critically ill patients.
Main Results:
- Key risk factors for hypoglycemia include changes in nutrition, diabetes mellitus, sepsis, shock, liver failure, and renal replacement therapy.
- Consequences of hypoglycemia in critically ill patients are not well-defined.
- Current evidence suggests the benefits of strict glycemic control outweigh potential negative effects of hypoglycemia.
Conclusions:
- Hypoglycemia should be avoided in critically ill patients, but not at the expense of less stringent glycemic control.
- Achieving strict glycemic control with low hypoglycemia incidence is possible using validated algorithms and increased surveillance.
- Targeted surveillance is crucial for patients at higher risk of hypoglycemia.
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