PT  - JOURNAL ARTICLE
AU  - Ghaith Alhatemi
AU  - Haider Aldiwani
AU  - Rafal Alhatemi
AU  - Marwah Hussein
AU  - Suzan Mahdai
AU  - Berhane Seyoum
TI  - Glycemic control in the critically ill: Less is more
AID  - 10.3949/ccjm.89a.20171
DP  - 2022 Apr 01
TA  - Cleveland Clinic Journal of Medicine
PG  - 191--199
VI  - 89
IP  - 4
4099  - http://www.ccjm.org/content/89/4/191.short
4100  - http://www.ccjm.org/content/89/4/191.full
SO  - Cleve Clin J Med2022 Apr 01; 89
AB  - Hyperglycemia is associated with poor clinical outcomes in critically ill patients. Initial clinical trials of intensive insulin therapy targeting blood glucose levels of 80 to 110 mg/dL showed improved outcomes, but subsequent trials found no benefits and even increased harm with this approach. Emerging literature has evaluated other glycemic indices including time-in-target blood glucose range, glycemic variability, and stress hyperglycemia ratio. These indices, while well described in observational studies, have not been addressed in the initial trials. Additionally, the patient’s pre existing diabetes status and preadmission diabetic control may modulate the outcomes of stringent glycemic control, with worse outcomes of hyperglycemia being observed in patients without diabetes and in those with well-controlled diabetes. Most medical societies recommend less stringent glucose control in the range of 140 to 180 mg/dL for critically ill patients.