Hyperglycemia in Critically Ill Patients: Current Approaches and Management Strategies

Hyperglycemia is frequently encountered in critically ill patients and is associated with adverse outcomes, including increased morbidity and mortality. It may be pre-existing due to diabetes mellitus or develop during hospitalization as stress hyperglycemia. This review aims to raise awareness among medical staff regarding the implications of hyperglycemia in critically ill patients, its pathophysiology, monitoring techniques, and current treatment protocols. Therefore, evidence from the international literature is analyzed, with specialized journals serving as reference points, focusing on the impact of glycemic variability, individualized patient management, and emerging technologies such as artificial intelligence-driven biosensors for glucose monitoring. Hyperglycemia is defined as a blood glucose level exceeding 7.0 mmol/l (125 mg/dl) before admission or surpassing 10.0 mmol/l (180 mg/dl) two hours postprandial. Monitoring can be conducted using arterial or capillary blood, continuous glucose monitoring systems, or artificial intelligence-enhanced biosensors. Regardless of their diabetic status, patients present unique clinical features. Those with pre-existing diabetes may experience hypoglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic state, electrolyte imbalances, and dehydration, necessitating meticulous monitoring and intervention. Special attention must be given to glycemic variability, maintaining levels between 3.8 and 10.0 mmol/l (70-180 mg/dl), and timely interventions to prevent complications. Current treatment protocols prioritize intravenous insulin infusion based on multiple clinical studies on hyperglycemic intensive care unit (ICU) patients. To minimize complications, maintaining glucose levels between 6.1 and 10.0 mmol/l (110-180 mg/dl) is recommended, balancing the risk of hypoglycemia. Hyperglycemia negatively impacts mortality due to systemic damage and the delayed detection of glucose dysregulation. This review underscores the necessity of personalized glycemic control strategies to improve patient outcomes in ICUs.