Updates in Glycemic Management in the Hospital
Purpose of Review
To provide an update of glycemic management during metabolic stress related to surgery or critical illness.
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.
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.
KeywordsStress hyperglycemia Insulin resistance Critically ill Postoperative care Insulin Glucose
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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