Journal
WORLD JOURNAL OF DIABETES
Volume 12, Issue 10, Pages 1719-1730Publisher
BAISHIDENG PUBLISHING GROUP INC
DOI: 10.4239/wjd.v12.i10.1719
Keywords
Brain injuries; Traumatic; Critical care; Diabetes mellitus; Glycemic control; Insulin infusion systems; Sepsis
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Illness-induced hyperglycemia can lead to detrimental effects such as promoting cellular damage and infections, and increasing mortality. Accurate monitoring of blood glucose levels and setting appropriate glycemic targets based on patient characteristics are crucial for optimal glucose control.
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.
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