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Stress hyperglycemia: an essential survival response!
Critical Care (London, England)
|March 9, 2013
Summary
Stress hyperglycemia in critically ill patients is an adaptive survival response, not a cause of poor outcomes. Tight glycemic control may be harmful, challenging current medical practices.
Area of Science:
- Critical care medicine
- Endocrinology
- Pathophysiology
Background:
- Stress hyperglycemia is common in critically ill patients and linked to disease severity and outcomes.
- Current clinical practice often assumes a causal link, leading to tight glycemic control protocols.
- This approach has not improved patient outcomes in intensive care units (ICUs) or general hospital settings.
Purpose of the Study:
- To critically appraise the literature on stress hyperglycemia and tight glycemic control.
- To explore the potential adaptive and protective role of hyperglycemia in acute illness.
- To review the pathophysiology of stress hyperglycemia and insulin resistance.
Main Methods:
- Literature review and critical appraisal of existing studies.
- Analysis of the association between glucose levels and patient outcomes.
- Examination of the evolutionary and physiological basis of stress hyperglycemia.
Main Results:
- Attempts at tight glycemic control in critically ill patients have not improved health outcomes.
- Stress hyperglycemia and insulin resistance appear to be evolutionarily preserved adaptive responses.
- These responses may enhance host survival during acute illness.
Conclusions:
- Hyperglycemia in acute illness is likely an adaptive survival mechanism.
- Interfering with this complex adaptive response may be detrimental.
- Rethinking the management of stress hyperglycemia is warranted.
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