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Hyperglycemia and glycemic control in critically ill and hospitalized patients
Research Guide
What is Hyperglycemia and glycemic control in critically ill and hospitalized patients?
Hyperglycemia and glycemic control in critically ill and hospitalized patients refers to elevated blood glucose levels in intensive care and hospital settings and the strategies, such as intensive insulin therapy, used to manage them to reduce morbidity, mortality, infection risk, and inflammatory responses.
This field encompasses 46,346 papers examining hyperglycemia's impact and glycemic control via intensive insulin therapy in critically ill surgical and medical patients. Van den Berghe et al. (2001) in "Intensive Insulin Therapy in Critically Ill Patients" showed that maintaining blood glucose at or below 110 mg per deciliter reduces morbidity and mortality in surgical ICU patients. The Nice-Sugar Study Investigators (2009) in "Intensive versus Conventional Glucose Control in Critically Ill Patients" found that targeting 81-108 mg per deciliter increased mortality compared to 180 mg per deciliter or less.
Topic Hierarchy
Research Sub-Topics
Intensive Insulin Therapy in Surgical ICU Patients
Randomized trials evaluate tight glycemic control protocols post-surgery, measuring impacts on wound healing, infections, and length of stay. Researchers optimize glucose targets and infusion algorithms.
Stress Hyperglycemia in Critically Ill Patients
Studies elucidate mechanisms of hyperglycemia during sepsis, trauma, and ARDS, linking to counter-regulatory hormones and insulin resistance. Outcomes include associations with organ failure and mortality.
Glycemic Control and Infection Risk in ICU
Meta-analyses quantify dose-response relationships between glucose levels and nosocomial infections like ventilator-associated pneumonia. Interventions test continuous glucose monitoring integration.
Hyperglycemia in Acute Myocardial Infarction
Admission glucose predicts adverse cardiac events independent of diabetes status, prompting trials of insulin-glucose-potassium infusions. Research explores inflammatory and thrombotic pathways.
Continuous Glucose Monitoring in Hospitalized Patients
CGM systems enable real-time glycemic variability assessment and closed-loop control in non-ICU wards. Validation studies address accuracy in shock states and cost-effectiveness.
Why It Matters
Glycemic control directly affects outcomes in ICUs, where hyperglycemia associates with higher infection risk, mortality, and inflammation in surgical and medical patients. Van den Berghe et al. (2001) demonstrated in a surgical ICU trial that intensive insulin therapy targeting blood glucose at or below 110 mg per deciliter reduced morbidity and mortality, influencing initial protocols worldwide. Conversely, the Nice-Sugar Study Investigators (2009) reported in a large international trial of 6,104 adults that intensive control to 81-108 mg per deciliter raised 90-day mortality to 27.5% versus 24.9% with conventional control to 180 mg per deciliter or less, prompting shifts to moderate targets and reducing hypoglycemia risks in practice.
Reading Guide
Where to Start
"Intensive Insulin Therapy in Critically Ill Patients" by Van den Berghe et al. (2001) first, as it provides the foundational evidence that intensive insulin targeting below 110 mg per deciliter reduces morbidity and mortality in surgical ICU patients, setting the stage for subsequent trials.
Key Papers Explained
Van den Berghe et al. (2001) in "Intensive Insulin Therapy in Critically Ill Patients" established benefits of tight control (≤110 mg/dL) in surgical ICUs, prompting Van den Berghe et al. (2006) in "Intensive Insulin Therapy in the Medical ICU" to test it in medical ICUs, where it reduced morbidity but not mortality. The Nice-Sugar Study Investigators (2009) in "Intensive versus Conventional Glucose Control in Critically Ill Patients" then scaled up internationally, showing harm from 81-108 mg/dL targets versus ≤180 mg/dL, refining protocols. DeFronzo et al. (1979) in "Glucose clamp technique: a method for quantifying insulin secretion and resistance" underpins measurement methods across these studies.
Paper Timeline
Most-cited paper highlighted in red. Papers ordered chronologically.
Advanced Directions
Current focus remains on balancing targets post-Nice-Sugar, with ADA standards like "Standards of Medical Care in Diabetes—2022" (2021) and time-in-range consensus from Battelino et al. (2019) in "Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range" guiding moderate control amid no recent preprints.
Papers at a Glance
| # | Paper | Year | Venue | Citations | Open Access |
|---|---|---|---|---|---|
| 1 | Intensive Insulin Therapy in Critically Ill Patients | 2001 | New England Journal of... | 10.0K | ✓ |
| 2 | Standards of Medical Care in Diabetes | 2006 | Diabetes Care | 8.7K | ✓ |
| 3 | Glucose clamp technique: a method for quantifying insulin secr... | 1979 | American Journal of Ph... | 7.4K | ✕ |
| 4 | Intensive versus Conventional Glucose Control in Critically Il... | 2009 | New England Journal of... | 5.0K | ✓ |
| 5 | 2. Classification and Diagnosis of Diabetes:<i>Standards of Me... | 2021 | Diabetes Care | 4.6K | ✓ |
| 6 | Standards of Medical Care in Diabetes—2014 | 2013 | Diabetes Care | 4.5K | ✓ |
| 7 | Standards of Medical Care in Diabetes—2013 | 2012 | Diabetes Care | 4.4K | ✓ |
| 8 | Intensive Insulin Therapy in the Medical ICU | 2006 | New England Journal of... | 3.6K | ✓ |
| 9 | Clinical Targets for Continuous Glucose Monitoring Data Interp... | 2019 | Diabetes Care | 3.5K | ✓ |
| 10 | Standards of Medical Care in Diabetes—2010 | 2009 | Diabetes Care | 3.4K | ✕ |
Frequently Asked Questions
What did the Leuven trial show about intensive insulin therapy?
Van den Berghe et al. (2001) in "Intensive Insulin Therapy in Critically Ill Patients" found that targeting blood glucose at or below 110 mg per deciliter with intensive insulin therapy reduced morbidity and mortality in surgical ICU patients. This approach lowered hospital mortality from 8.0% in conventional controls to 4.6% in the intensive group.
How did the Nice-Sugar trial compare intensive and conventional glucose control?
The Nice-Sugar Study Investigators (2009) in "Intensive versus Conventional Glucose Control in Critically Ill Patients" showed that intensive control targeting 81-108 mg per deciliter increased 90-day mortality to 27.5% compared to 24.9% with conventional control at 180 mg per deciliter or less. This international trial involved 6,104 ICU adults and highlighted risks of tight control.
What were the results of intensive insulin in medical ICU patients?
Van den Berghe et al. (2006) in "Intensive Insulin Therapy in the Medical ICU" reported that intensive insulin therapy reduced morbidity but not overall mortality in medical ICU patients. Morbidity decreased significantly, particularly in patients treated for three or more days.
What methods quantify insulin resistance and secretion in glycemic studies?
DeFronzo et al. (1979) in "Glucose clamp technique: a method for quantifying insulin secretion and resistance" described the hyperglycemic clamp to raise plasma glucose 125 mg/dl above basal for beta-cell sensitivity and the euglycemic clamp for tissue insulin sensitivity. These techniques provide quantitative measures used in critical care glycemic research.
What do ADA standards address in diabetes care for hospitalized patients?
Papers like "Standards of Medical Care in Diabetes—2022" (2021) from the American Diabetes Association outline screening, classification, diagnosis, and general treatment goals including glycemic control components. These recommendations guide quality evaluation in hospitalized and critically ill diabetic patients.
Open Research Questions
- ? What glycemic targets optimize outcomes without increasing hypoglycemia risk in mixed surgical-medical ICUs?
- ? How does hyperglycemia duration and severity independently predict infection and mortality beyond initial glucose levels?
- ? Which patient subgroups in medical ICUs benefit most from intensive insulin therapy after three days?
- ? What role does the inflammatory response play in hyperglycemia's association with myocardial infarction and stroke in critical illness?
- ? How can continuous glucose monitoring targets be refined for critically ill patients based on time-in-range metrics?
Recent Trends
The field includes 46,346 works with steady output reflected in annually updated ADA "Standards of Medical Care in Diabetes" papers, such as the 2021 edition cited 4,561 times, emphasizing refined glycemic targets post-Nice-Sugar findings.
Battelino et al. advanced continuous glucose monitoring targets with time-in-range recommendations amid growing sensor adoption, though no preprints or news in the last 12 months indicate stable protocols.
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