Glycemic Targets for the Critically Ill Patient

Hyun Min Kim; Jaetaek Kim

doi:10.4093/jkd.2015.16.1.18

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Kim and Kim: Glycemic Targets for the Critically Ill Patient

Focused Issue

J Korean Diabetes 2015;16(1):18-24.

Published online: 20 January 2015

DOI: https://doi.org/10.4093/jkd.2015.16.1.18

Glycemic Targets for the Critically Ill Patient

Hyun Min Kim, Jaetaek Kim

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea

Corresponding author: Jaetaek Kim Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul 156-861, Korea, E-mail: jtkim@cau.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Critically ill patients often experience hyperglycemia, which may be associated with increased morbidity and mortality. In 2001, van den Berghe et al. suggested significant benefit of normalization of blood glucose level in critically ill patients using intensive intravenous insulin therapy. Subsequent multicenter randomized studies, however, demonstrated adverse effects of tight glucose control. Therefore, while the need for glucose control in critically ill patients is generally accepted, the treatment thresholds for initiation of insulin therapy or target glucose values are still undetermined. Furthermore, occurrence of a hypoglycemic event during intensive insulin therapy is known to be an independent predictor of clinical outcome, and glycemic variability is an important variable of glucose management in the critically ill patients. Novel technological approaches such as a continuous glucose monitoring system (CGMS) might help to overcome some problems of tight glucose control by reducing the risk of hypoglycemia and minimizing glycemic variability.

Keywords: Critical illness, Hyperglycemia, Intensive care units

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Table 1.

Summary of current professional society guideline for glycemic control in critical illness

Organization	Year	Patient population	Treatment threshold for initiation of intensive insulin therapy (mg/dL)	Target glucose level (mg/dL)
Korean Diabetes Association [11]	2011	Critical ill patients	180	140∼180
American Diabetes Association [10]	2015	ICU patients	180	140∼180
Surviving Sepsis Campaign [12]	2013	ICU patients	180	≤ 180
American Heart Association [13]	2012	ICU patients with acute coronary syndromes	180	< 180
American College of Physicians [14]	2014	ICU patients		140∼200

ICU, intensive care unit.

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