Glycemic control in the critically ill: What have we learned since NICE-SUGAR?

Area of Science:

• Critical Care Medicine
• Endocrinology
• Metabolic Disorders

Background:

• The Normoglycemia in Intensive Care Evaluation - Survival Using Glucose Algorithm Regulation trial (2009) linked intensive blood glucose control to increased mortality in critically ill patients.
• This led to reduced enthusiasm for 'tight glucose control' in intensive care units (ICUs).
• However, ongoing research has refined understanding of glycemic control limitations and clinical aspects.

Purpose of the Study:

• To review recent research (last 6 years) on glycemic control in critically ill patients.
• To explore key domains of glycemic control: hyperglycemia, hypoglycemia, and glucose variability.
• To examine the role of diabetic status and premorbid glucose control.

Main Methods:

• Literature review of studies published in the last six years.
• Analysis of research on glycemic control domains and their impact on mortality.
• Evaluation of factors influencing glycemic control, such as measurement frequency and time in target range.

Main Results:

• Advances in understanding hyperglycemia, hypoglycemia, and glucose variability in critically ill patients.
• Diabetic status and premorbid glucose control significantly modulate the relationship between glycemic control and mortality.
• Measurement frequency is crucial for achieving target blood glucose control.
• Time in targeted blood glucose range emerges as a potentially unifying metric.

Conclusions:

• Glycemic control in critically ill patients requires nuanced understanding beyond simple 'tight control'.
• Individual patient factors, particularly diabetic status, are critical.
• Optimizing blood glucose monitoring and considering time in target range are key for improved outcomes.