Journal
CURRENT OPINION IN CLINICAL NUTRITION AND METABOLIC CARE
Volume 15, Issue 2, Pages 151-160Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MCO.0b013e32834f0009
Keywords
diabetes; glycemic variability; hyperglycemia; hypoglycemia; intensive care; mortality
Categories
Funding
- Edwards Life Sciences
- Roche Diagnostics
- Sanofi-Aventis
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Purpose of review Hyperglycemia, hypoglycemia and increased glycemic variability are independently associated with increased risk of mortality in critically ill patients. The purpose of this review is to evaluate the evidence from interventional trials of intensive insulin therapy, as well as observational cohort studies, relating premorbid diabetic status and these three domains of glycemic control to mortality. Recent findings Hyperglycemia has a stronger association with mortality in critically ill patients without diabetes than in those with diabetes. Hypoglycemia is independently associated with increased risk of mortality in both populations. Limited data suggest that increased glycemic variability may have a stronger association with mortality in patients without diabetes than in those with diabetes. Summary Premorbid diabetic status impacts the relationship of the three domains of glycemic control to risk of mortality in critically ill patients. The data presented in this review are hypothesis generating; future trials of IIT in the critically ill should stratify management and outcomes by premorbid diabetic status.
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