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Is it time to abandon glucose control in critically ill adult patients?

Krinsley, James S.a; Preiser, Jean-Charlesb

Current Opinion in Critical Care: August 2019 - Volume 25 - Issue 4 - p 299–306
doi: 10.1097/MCC.0000000000000621
METABOLIC SUPPORT: Edited by Mette M. Berger

Purpose of review To summarize the advances in literature that support the best current practices regarding glucose control in the critically ill.

Recent findings There are differences between patients with and without diabetes regarding the relationship of glucose metrics during acute illness to mortality. Among patients with diabetes, an assessment of preadmission glycemia, using measurement of Hemoglobin A1c (HgbA1c) informs the choice of glucose targets. For patients without diabetes and for patients with low HgbA1c levels, increasing mean glycemia during critical illness is independently associated with increasing risk of mortality. For patients with poor preadmission glucose control the appropriate blood glucose target has not yet been established. New metrics, including stress hyperglycemia ratio and glycemic gap, have been developed to describe the relationship between acute and chronic glycemia.

Summary A ‘personalized’ approach to glycemic control in the critically ill, with recognition of preadmission glycemia, is supported by an emerging literature and is suitable for testing in future interventional trials.

aDepartment of Medicine, Stamford Hospital, Columbia Vagelos College of Physicians and Surgeons, Connecticut, USA

bDepartment of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Belgium

Correspondence to James S. Krinsley, MD, FCCM, FCCP, Stamford Hospital, Stamford, Columbia Vagelos College of Physicians and Surgeons, CT 06902, USA. Tel: +1 203 348 2437; e-mail:

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