Abstract
The major interventional trials of intensive insulin therapy in critically ill patients have reached divergent results. The present viewpoint article explores some of the potential reasons, including differences in monitoring technology and protocol design and performance, the occurrence of severe hypoglycemia and changes in the standard of care since publication of the landmark single-center trial. Recently published data detailing the deleterious effect of hypoglycemia are discussed, as is the emerging body of literature describing the important impact of glycemic variability on the risk of mortality in heterogeneous populations of acutely ill and severely ill patients. These new findings have important implications for the design of future interventional trials of intensive insulin therapy in the intensive care unit setting.
Highlights
The major interventional trials of intensive insulin therapy in critically ill patients have reached divergent results
These measurements are frequently performed in unstable patients with dynamic degrees of insulin resistance and risk of hypoglycemia [22]
A retrospective analysis of a cohort of 5,365 patients admitted to a single medical–surgical intensive care unit (ICU) demonstrated that the odds ratio (OR) for mortality associated with a single episode of severe hypoglycemia (SH) was 2.28 (95% confidence interval (CI) = 1.41 to 3.70, P = 0.008) [25]
Summary
Evaluation of nursing work effort and perceptions about blood glucose testing in tight glycemic control. Lacherade JC, Jacqueminet S, Preiser JC: An overview of hypoglycemia in the critically ill. Krinsley JS, Grover A: Severe hypoglycemia in critically ill patients: risk factors and outcomes. Bagshaw SM, Egi M, George C, Bellomo R: Early blood glucose control and mortality in critically ill patients in Australia. M, Bellomo R, Stachowski E, French CJ, Hart GK, Taori G, Hegarty C, Bailey M: Hypoglycemia and outcome in critical illness. Am J Respir Crit Care Med 2010, 181:134-142. Meyfroidt G, Keenan DM, Wang X, Wouters PJ, Veldhuis JD, Van den Berghe G: Dynamic characteristics of blood glucose time series during the course of critical illness: effects of intensive insulin therapy and relative association with mortality.
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