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Review
. 2021 Oct 15;12(10):1719-1730.
doi: 10.4239/wjd.v12.i10.1719.

Glycemic targets in critically ill adults: A mini-review

Kay Choong See  1
Affiliations
Review

Glycemic targets in critically ill adults: A mini-review

Kay Choong See. World J Diabetes. .

Abstract

Illness-induced hyperglycemia impairs neutrophil function, increases pro-inflammatory cytokines, inhibits fibrinolysis, and promotes cellular damage. In turn, these mechanisms lead to pneumonia and surgical site infections, prolonged mechanical ventilation, prolonged hospitalization, and increased mortality. For optimal glucose control, blood glucose measurements need to be done accurately, frequently, and promptly. When choosing glycemic targets, one should keep the glycemic variability < 4 mmol/L and avoid targeting a lower limit of blood glucose < 4.4 mmol/L. The upper limit of blood glucose should be set according to casemix and the quality of glucose control. A lower glycemic target range (i.e., blood glucose 4.5-7.8 mmol/L) would be favored for patients without diabetes mellitus, with traumatic brain injury, or who are at risk of surgical site infection. To avoid harm from hypoglycemia, strict adherence to glycemic control protocols and timely glucose measurements are required. In contrast, a higher glycemic target range (i.e., blood glucose 7.8-10 mmol/L) would be favored as a default choice for medical-surgical patients and patients with diabetes mellitus. These targets may be modified if technical advances for blood glucose measurement and control can be achieved.

Keywords: Brain injuries; Critical care; Diabetes mellitus; Glycemic control; Insulin infusion systems; Sepsis; Traumatic.

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Conflict of interest statement

Conflict-of-interest statement: See KC has received honoraria from GE Healthcare and Medtronic, and has no other conflicts of interest to disclose.

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