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Published on: June 11, 2012
Dysglycemia in the critically ill patient: current evidence and future perspectives
Ignacio Aramendi1, Gastón Burghi1, William Manzanares2
1Centro Nacional de Quemados, Hospital de Clínicas Dr. Manuel Quintela, Facultad de Medicina, Universidad de la República - Montevideo, Uruguay.
Abstract:
Dysglycemia in critically ill patients (hyperglycemia, hypoglycemia, glycemic variability and time in range) is a biomarker of disease severity and is associated with higher mortality. However, this impact appears to be weakened in patients with previous diabetes mellitus, particularly in those with poor premorbid glycemic control; this phenomenon has been called "diabetes paradox". This phenomenon determines that glycated hemoglobin (HbA1c) values should be considered in choosing glycemic control protocols on admission to an intensive care unit and that patients' target blood glucose ranges should be adjusted according to their HbA1c values. Therefore, HbA1c emerges as a simple tool that allows information that has therapeutic utility and prognostic value to be obtained in the intensive care unit.
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