Glycemic control in critically ill: A moving target

Area of Science:

• Critical Care Medicine
• Endocrinology
• Metabolic Disorders

Background:

• Glycemic control in intensive care units (ICUs) is complex, involving multiple patient factors.
• Hyperglycemia, hypoglycemia, and glycemic variability present distinct challenges in critically ill patients.

Purpose of the Study:

• To outline the key domains of glycemic control in ICUs.
• To discuss the implications of patient population and diabetic status on glycemic targets.
• To highlight the detrimental effects of hypoglycemia and glycemic variability.

Main Methods:

• Review of existing literature on glycemic control in ICUs.
• Analysis of patient populations, including surgical and medically ill patients.
• Consideration of diabetic status and its influence on glycemic tolerance.

Main Results:

• Excessive hyperglycemia should be avoided, with upper limits varying by patient type and diabetic status.
• Hypoglycemia is detrimental across all critically ill patient groups and must be prevented.
• Glycemic variability is increasingly recognized as harmful and requires targeted reduction.

Conclusions:

• Glycemic control protocols must address hyperglycemia, hypoglycemia, and variability.
• Patient-specific factors influence optimal glycemic targets.
• Emerging technologies like continuous glucose monitoring can aid in managing these three domains.