Diabetes Management Strategies in Intensive Care Settings

Critically ill patients often develop hyperglycemia, which is associated with increased morbidity and mortality. Randomized controlled trials have shown that the benefits of tight glucose control (TGC) are context-dependent. TGC reduced morbidity and mortality in patients receiving early parenteral nutrition, using a protocol that included accurate glucose measurements and avoided insulin boluses. Benefit was less pronounced in patients not receiving early parenteral nutrition, which is associated with less severe hyperglycemia. Conversely, TGC caused harm when the protocol induced severe hypoglycemia and glucose variability by inaccurate measurements and insulin boluses. Altogether, evidence suggests to, at least, prevent severe hyperglycemia and hypoglycemia.