Volume 13
Number 3
Aug 2009
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Review
HF Borggreve, DF Zandstra, JJM ligtenberg

Glucose control using insulin therapy is implemented in most intensive care units (ICU). While some studies show that glucose control results in better outcomes in critically ill patients, it is associated with an increase in hypoglycaemia. The optimal blood glucose value (BG) is the subject of debate. In this review, we address the outcomes in morbidity and mortality of insulin protocols in the ICU aimed at different BG target ranges. There is not sufficient evidence to recommend very strict BG regulation, though moderate glycaemic control might still result in mortality and morbidity benefit of critically ill patients. Less variability of BG might be beneficial. It is hard to identify clear differentiation of treatment effects in diagnostic subgroups. Implementation of glycaemic control is associated with a highly variable increase in hypoglycaemic rate and increase in number of BG measurements. Prudence dictates hypoglycaemia should be avoided as much as possible. Practical considerations on the work floor should be taken into account while choosing a BG target range that can be safely and effectively achieved.


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