Advances in Glucose Monitoring and Insulin Therapy in Intensive Care Unit Patients

Tae Nyun Kim

doi:10.4093/jkd.2018.19.4.224

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Kim: Advances in Glucose Monitoring and Insulin Therapy in Intensive Care Unit Patients

Focused Issue

J Korean Diabetes 2018;19(4):224-231.

Published online: 10 January 2018

DOI: https://doi.org/10.4093/jkd.2018.19.4.224

Advances in Glucose Monitoring and Insulin Therapy in Intensive Care Unit Patients

Tae Nyun Kim^1,²

¹Division of Endocrinology and Metabolism, Department of Internal Medicine, Busan, Korea

²Cardiovascular and Metabolic Disease Center, Inje University College of Medicine, Busan, Korea

Corresponding author: Tae Nyun Kim Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Haeundae Paik Hospital, 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea, E-mail: kimtn031@gmail.com

Received 13 November 2018 Accepted 23 November 2018

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

Since the multicenter Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation (NICE-SUGAR) study was published, the pursuit of tight glycemic control (TGC) among intensive care unit (ICU) patients has been seen as counterproductive and moderate glycemic control has become standard practice in ICUs. However, thus far, there is good evidence that hypoglycemia and hyperglycemia are associated with worse outcomes in ICU patients. Recently, the importance of improving time in band and reducing hypoglycemic episodes and glycemic variability has been more recognized. Compared to intermittent monitoring systems, continuous glucose monitoring (CGM) can have greater clinical benefit in terms of the prevention of severe hyperglycemia and hypoglycemia by enabling insulin infusions to be adjusted more rapidly and accurately. In this review, modern methods for glucose control in the ICU are presented, as well as future perspectives including the development of CGM and semiautomated glucose control, such as closed-loop systems.

Keywords: Glucose, Hyperglycemia, Hypoglycemia, Insulin, Intensive care units

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