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Are closed-loop systems for intensive insulin therapy ready for prime time in the ICU?

Okabayashi, Takehiro; Shima, Yasuo

Current Opinion in Clinical Nutrition & Metabolic Care: March 2014 - Volume 17 - Issue 2 - p 190–199
doi: 10.1097/MCO.0000000000000026
NUTRITION AND THE INTENSIVE CARE UNIT: Edited by Jeffrey I. Mechanick and Mette M. Berger

Purpose of review: Recent findings suggest that the effects of tight glycemic control (TGC) performing intensive insulin therapy (IIT) in medical and surgical ICU have had conflicting results. The purpose of this review is to summarize the current evidence in humans how closed-loop systems for IIT are ready for prime time in the ICU.

Recent findings: Current evidence suggests that maintaining normoglycemia postoperatively can improve the outcome and reduce the mortality and morbidity of critically ill patients by TGC performing IIT according to the large randomized trials. However, trials examining the effects of TGC have had conflicting results. Systematic reviews and meta-analyses have also led to differing conclusions. The main reason these clinical trials and meta-analyses were negative results for TGC was because of the high incidence of hypoglycemia. This could not be prevented as there is no reliable technique currently able to avoid this condition during IIT. The development of accurate, continuous blood glucose monitoring devices, and closed-loop systems for computer-assisted blood glucose control in the ICU, will probably help avoid hypoglycemia in these situations.

Summary: The challenge in the hospital setting demonstrated that a closed-loop glycemic control system is expected to the achievement of TGC with no occurrence of hypoglycemia induced by IIT after surgery. Closed-loop glycemic control systems for IIT are now ready for prime time in the ICU.

Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi City, Kochi, Japan

Correspondence to Takehiro Okabayashi, MD, PhD, Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi City, Kochi 781-8555, Japan. Tel: +81 88 837 3000; fax: +81 88 837 6766; e-mail:

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