Currently, many providers treat hyperglycemia in the critically ill based on guidelines suggesting target glucose ranges between 140 and 180 mg/dL. However, recent literature has attempted to challenge this by comparing the effect of intensive insulin therapy (IIT) to conventional insulin therapy. Four studies examining the impact of IIT and conventional insulin therapy on mortality in critically ill patients were examined and analyzed. The outcomes from these studies are mixed with neither therapy showing marked improvement in morbidity and mortality rates; in fact, these studies showed a trend toward increased mortality related to an increased incidence of hypoglycemia with IIT. Factors such as days of mechanical ventilation, infection rates, length of stay in the ICU, and incidence of organ failure were included as secondary end points. The data suggest IIT may improve patient outcomes in some areas, but the data are not statistically significant, and adoption of an IIT protocol is not recommended at this time.
Critically ill patients must maintain appropriate glycemic control in order to facilitate healing. This article discusses the current research on glucose control in medical and surgical patients, comparing intensive tight glucose control to more conventional glucose management and introducing rationale for evidence-based practice guidelines.
Lauren Schiffner, MSN, CRNP, AGACNP-BC, CCRN, is a surgical/trauma critical care nurse at the Hospital of the University of Pennsylvania and a recently graduated adult gerontology acute care nurse practitioner from the University of Pennsylvania School of Nursing.
The author has disclosed that she has no significant relationships with, or financial interest in any commercial companies pertaining to this article.
Address correspondence and reprint requests to: Lauren Schiffner, MSN, CRNP, AGACNP-BC, CCRN, 1232 E Oxford St, Philadelphia, PA 19125 (Laubau6@gmail.com).