Insulin therapy associated relative hypoglycemia during critical illness

Kwan, Timothy N; Marhoon, Nada; Young, Marcus; Holmes, Natasha E; Bellomo, Rinaldo

doi:10.1016/j.jcrc.2022.154018

Cited by 5 publications

(4 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, growing evidence indicates that whereas higher ICU blood glucose is strongly associated with higher mortality in patients with stress hyperglycemia who do not have diabetes, higher ICU blood glucose is associated with lower mortality in patients with preexisting diabetes and high HbA 1c (e.g., $8.0%) (Fig. 1) (10)(11)(12)(13)(14)(15). While the specific mechanism of injury remains to be established, relative hypoglycemia and the adverse impact of CRRs on patient outcomes are leading candidates.…”

Section: Glycemia and Mortality Risk In The Icumentioning

confidence: 99%

“…In the ICU setting, relative hypoglycemia is defined as having occurred following either a $30% decrease from estimated preadmission glycemia (11,12) or any drop into the blood glucose range of 70-110 mg/dL (or 3.9-6.1 mmol/L) for patients with preadmission HbA 1c $8.0% (13). Evidence that mortality risk increases significantly among ICU patients meeting these criteria (10-15) has prompted calls for an individualized approach that takes the preadmission, time-averaged glucose level into account (based on HbA 1c levels) (15).…”

Section: Glycemia and Mortality Risk In The Icumentioning

confidence: 99%

“…Consequently, CRRs are mounted at normal or even elevated blood glucose levels in patients with relative hypoglycemia (6)(7)(8)(9), posing a serious risk to patients with underlying critical illness. As discussed in greater detail below, relative hypoglycemia has emerged as a major clinical concern because the standard glycemic target recommended for patients in the ICU (100-180 mg/dL) is associated with increased mortality risk among some critically ill patients with diabetes (10)(11)(12)(13)(14)(15). Although mechanisms underlying this increased risk remain to be established, the stress of relative hypoglycemia and associated CRRs is likely to contribute.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Brain Glucose Sensing and the Problem of Relative Hypoglycemia

et al. 2023

View full text Add to dashboard Cite

“Relative hypoglycemia” is an often-overlooked complication of diabetes characterized by an increase in the glycemic threshold for detecting and responding to hypoglycemia. The clinical relevance of this problem is linked to growing evidence that among patients with critical illness, higher blood glucose in the intensive care unit is associated with higher mortality among patients without diabetes but lower mortality in patients with preexisting diabetes and an elevated prehospitalization HbA1c. Although additional studies are needed, the cardiovascular stress associated with hypoglycemia perception, which can occur at normal or even elevated glucose levels in patients with diabetes, offers a plausible explanation for this difference in outcomes. Little is known, however, regarding how hypoglycemia is normally detected by the brain, much less how relative hypoglycemia develops in patients with diabetes. In this article, we explore the role in hypoglycemia detection played by glucose-responsive sensory neurons supplying peripheral vascular beds and/or circumventricular organs. These observations support a model wherein relative hypoglycemia results from diabetes-associated impairment of this neuronal glucose-sensing process. By raising the glycemic threshold for hypoglycemia perception, this impairment may contribute to the increased mortality risk associated with standard glycemic management of critically ill patients with diabetes.

show abstract

Section: Glycemia and Mortality Risk In The Icumentioning

confidence: 99%

Section: Glycemia and Mortality Risk In The Icumentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Brain Glucose Sensing and the Problem of Relative Hypoglycemia

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Observational data consistently report that the association between death and hyperglycemia is markedly affected by preexisting glucose control [23–26]. Moreover, the risk of treatment-induced hypoglycemia, a strong predictor of increased mortality, is greatest in those with preexisting hyperglycemia [27,28]. A recent single-center retrospective cohort study of 3,625 patients with at least four blood glucose measurements and a HbA1c measurement reported that for patients with a HbA1c ≥ 8.0% mortality was lower if the proportion of time spent with a blood glucose between 180 and 250 mg/dL (10 and 14 mmol/L) was greater [29 ▪ ].…”

Section: Updates For Glucose Targetsmentioning

confidence: 99%

Update on glucose control during and after critical illness

Deane

Plummer

Abdelhamid

2022

Current Opinion in Critical Care

View full text Add to dashboard Cite

Purpose of reviewThere is a complex bidirectional relationship between critical illness and disordered glucose metabolism. This review aims to provide a comprehensive summary of the recent evidence focused on the relationship between critical illness and disordered glucose metabolism through the distinct phases of prior to, during, and after an acute illness that requires admission to the intensive care unit (ICU).Recent findingsRecent data suggest that preexisting glucose metabolism affects the optimal blood glucose target during critical illness, with preliminary data suggesting that glucose targets should be ‘personalized’ based on preexisting glycemia. Because of the close association between critical illness and disordered glucose metabolism, there is a need to optimize glucose monitoring in the ICU with rapid, precise, and cost-efficient measurements at the bedside. Recent studies have evaluated the use of various methodologies, with a focus on the use of near-continuous glucose monitoring. For those patients with preexisting diabetes who survive ICU, nocturnal hypoglycemia may be an unrecognized and important issue when discharged to the ward. There is increasing evidence that patients with high blood glucose during their acute illness, so called ‘stress hyperglycemia’, are at increased risk of developing diabetes in the years following recovery from the inciting event. Critically ill patients with COVID-19 appear at greater risk.SummaryThere have been important recent insights in the approach to glucose monitoring and glucose targets during critical illness, monitoring and administration of glucose-lowering drugs on discharge from the ICU, and longitudinal follow-up of patients with stress hyperglycemia.

show abstract

Contrôle glycémique

Ichai

Preiser²

2023

Anesthésie & Réanimation

View full text Add to dashboard Cite

Insulin therapy associated relative hypoglycemia during critical illness

Cited by 5 publications

References 28 publications

Brain Glucose Sensing and the Problem of Relative Hypoglycemia

Brain Glucose Sensing and the Problem of Relative Hypoglycemia

Update on glucose control during and after critical illness

Contrôle glycémique

Contact Info

Product

Resources

About