Open AccessGlycemic control in critically ill patients: What to do post NICE-SUGAR?
Author(s) -
Paul E. Marik
Publication year - 2009
Publication title -
world journal of gastrointestinal surgery
Language(s) - English
Resource type - Journals
ISSN - 1948-9366
DOI - 10.4240/wjgs.v1.i1.3
Subject(s) - glycemic , medicine , critically ill , intensive care , intensive care medicine , insulin , stress hyperglycemia , blood sugar , intensive care unit , nice , diabetes mellitus , endocrinology , computer science , programming language
Until recently, stress hyperglycemia was considered to be a beneficial adaptive response, with raised blood glucose providing a ready source of fuel for the brain, skeletal muscle, heart and other vital organs at a time of increased metabolic demand. Following the Leuven Intensive Insulin Therapy Trial in 2001, tight glycemic control became rapidly adopted as the standard of care in intensive care units (ICU's) throughout the world. However, four randomized controlled studies and the recently published NICE-SUGAR study have subsequently been unable to replicate the findings of the Leuven Intensive Insulin Therapy Trial. This paper offers an explanation for these discordant findings, and provides a practical approach to glucose control in the ICU.