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Current Diabetes Reports

, 19:133 | Cite as

Updates in Glycemic Management in the Hospital

  • Wasineenart Mongkolpun
  • Bruna Provenzano
  • Jean-Charles PreiserEmail author
Hospital Management of Diabetes (A Wallia and JJ Seley, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Hospital Management of Diabetes

Abstract

Purpose of Review

To provide an update of glycemic management during metabolic stress related to surgery or critical illness.

Recent Findings

There is a clear association between severe hyperglycemia, hypoglycemia, and high glycemic variability and poor outcomes of postoperative or critically ill patients. However, the impressive beneficial effects of tight glycemic management (TGM) by intensive insulin therapy reported in one study were never reproduced. Hence, the recommendation of TGM is now replaced by more liberal blood glucose (BG) targets (< 180 mg/dL or 10 mM). Recent data support the concept of targeting individualized blood glucose (BG) values according to the presence of diabetes mellitus/chronic hyperglycemia, the presence of brain injury, and the time from injury.

Summary

A more liberal glycemic management goal is currently advised during metabolic stress and could be switched to individualized glycemic management once validated by prospective trials.

Keywords

Stress hyperglycemia Insulin resistance Critically ill Postoperative care Insulin Glucose 

Notes

Compliance with Ethical Standards

Conflict of Interest

Wasineenart Mongkolpun and Bruna Provenzano declare that they have no conflict of interest.

Jean-Charles Preiser reports personal fees from Optiscan, Edwards Lifesciences, and Medtronic.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Wasineenart Mongkolpun
    • 1
  • Bruna Provenzano
    • 1
  • Jean-Charles Preiser
    • 1
    Email author
  1. 1.Department of Intensive CareErasme University Hospital, Université Libre de BruxellesBrusselsBelgium

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