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Glycemic control in critically ill patients: What to do post NICE-SUGAR?
1Paul E Marik, Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, United States.
World Journal of Gastrointestinal Surgery
|December 17, 2010
Summary
Stress hyperglycemia was once thought beneficial, but recent studies challenge tight glycemic control in intensive care units (ICUs). This paper explains conflicting results and offers practical glucose management strategies for ICUs.
Area of Science:
- Critical care medicine
- Endocrinology
- Metabolic regulation
Background:
- Stress hyperglycemia was historically viewed as an adaptive response, supplying fuel during increased metabolic demand.
- The Leuven Intensive Insulin Therapy Trial (2001) led to widespread adoption of tight glycemic control in intensive care units (ICUs).
- Subsequent research, including four randomized controlled trials and the NICE-SUGAR study, has failed to replicate the Leuven trial's findings.
Purpose of the Study:
- To explain the reasons for discordant findings regarding tight glycemic control in ICUs.
- To provide a practical approach for glucose management in the intensive care setting.
Main Methods:
- Review of key randomized controlled trials on glycemic control in ICUs.
- Analysis of the Leuven Intensive Insulin Therapy Trial and the NICE-SUGAR study.
- Development of a practical glucose control strategy based on current evidence.
Main Results:
- The benefits of tight glycemic control in ICUs, as suggested by the Leuven trial, have not been consistently replicated.
- Conflicting results suggest that the optimal approach to glucose control in ICUs may require re-evaluation.
- The paper proposes an explanation for these discrepancies in study outcomes.
Conclusions:
- The standard of care for glycemic control in ICUs needs reassessment due to conflicting evidence.
- A nuanced, practical approach to managing blood glucose in critically ill patients is necessary.
- Further research may be needed to refine glucose control targets and methods in the ICU.
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