Glycemic control in non-diabetic critically ill patients

• Authors: Farnoosh Farrokhi, Emory University; Dawn Smiley, Emory University; Guillermo Umpierrez, Emory University
• Journal Title: Best Practice and Research: Clinical Endocrinology and Metabolism
• Volume: Volume 25, Number 5
• Publisher: Elsevier: 12 months | 2011-10, Pages 813-824
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.beem.2011.05.004
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, General
• Keywords: stress hyperglycemia; inpatient hyperglycemia; hospital hyperglycemia; ICU

Abstract

Hyperglycemia is a common and costly health care problem in hospitalized patients. In hospital hyperglycemia is defined as any glucose value >7.8 mmol/l (140 mg/dl). Hyperglycemia is present in 40% of critically ill patients and in up to 80% of patients after cardiac surgery, with ~ 80% of ICU patients with hyperglycemia having no history of diabetes prior to admission. The risk of hospital complications relates to the severity of hyperglycemia, with a higher risk observed in patients without a history of diabetes compared to those with known diabetes. Improvement in glycemic control reduces hospital complications and mortality; however, the ideal glycemic target has not been determined. A target glucose level between 7.8 and 10.0 mmol/l (140 and 180 mg/dl) is recommended for the majority of ICU patients. This review aims to present updated recommendations for the inpatient management of hyperglycemia in critically ill patients with and without a history of diabetes.