Treatment thresholds for hyperglycemia in critically ill patients with and without diabetes

Marik, Paul E.; Egi, Moritoki

doi:10.1007/s00134-014-3344-2

Cited by 27 publications

(22 citation statements)

References 16 publications

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“…As noted above, in diabetic patients, particularly those with persistent hyperglycemia, significantly lowering glucose levels and strict glycemic control may lead to symptomatic and life-threatening hypoglycemia and glycemic variability[19]. Glycemic variability has been defined as acute glycemic fluctuations; with both upwards fluctuations (in hypoglycemic correction) and downward fluctuations (in initial overbearing hypoglycemic treatment) leading to increased oxidative stress (which in turn leads to endothelial dysfunction and vascular damage).…”

Section: Stress-induced Hyperglycemiamentioning

confidence: 99%

“…Glycemic variability has been defined as acute glycemic fluctuations; with both upwards fluctuations (in hypoglycemic correction) and downward fluctuations (in initial overbearing hypoglycemic treatment) leading to increased oxidative stress (which in turn leads to endothelial dysfunction and vascular damage). It is well documented that glycemic variability is much more dangerous than persistent hyperglycemia in critically ill patients[19,20]. …”

Section: Stress-induced Hyperglycemiamentioning

confidence: 99%

“…Additional newer studies have concluded similarly, that diabetic patients do not share the same mortality with hyperglycemia as non-diabetic patients, and that these diabetic patients may benefit from higher glycemic ranges to reduce the risk of hypoglycemia and glycemic variability[35-37]. Moreover, another study recommended maintaining serum glucose levels between 160-220 mg/dL in patients with HbA1c above 7%, and to maintain serum glucose levels between 140-200 mg/dL in patients with an HbA1c below 7%[19]. …”

Section: Guidelines Recommendationsmentioning

confidence: 99%

“…The fourth study takes into account the risk of hypoglycemia, and recommends looser glycemic control to reduce moderate to severe hypoglycemia and glycemic variability[9]. However, all of these studies fail to take into account that diabetic individuals with persistent hyperglycemia (HbA1c above 7%) who are at higher risk from hypoglycemia-related mortality than hyperglycemia-related mortality[19,34]. A 2016 study on diabetic ICU patients, recommended keeping serum glucose levels below 250 mg/dL in patients with HbA1c above 7% upon admission to the ICU[9].…”

Section: Glycemic Control Therapymentioning

confidence: 99%

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Management of critically ill patients with diabetes

Silva-Perez

Benitez-Lopez

Varon

et al. 2017

WJD

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Disorders of glucose homeostasis, such as stress-induced hypoglycemia and hyperglycemia, are common complications in patients in the intensive care unit. Patients with preexisting diabetes mellitus (DM) are more susceptible to hyperglycemia, as well as a higher risk from glucose overcorrection, that may results in severe hypoglycemia. In critically ill patients with DM, it is recommended to maintain a blood glucose range between 140-180 mg/dL. In neurological patients and surgical patients, tighter glycemic control (i.e., 110-140 mg/d) is recommended if hypoglycemia can be properly avoided. There is limited evidence that shows that critically ill diabetic patients with a glycosylated hemoglobin levels above 7% may benefit from looser glycemic control, in order to reduce the risk of hypoglycemia and significant glycemic variability.

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Section: Stress-induced Hyperglycemiamentioning

confidence: 99%

Section: Stress-induced Hyperglycemiamentioning

confidence: 99%

Section: Guidelines Recommendationsmentioning

confidence: 99%

Section: Glycemic Control Therapymentioning

confidence: 99%

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Management of critically ill patients with diabetes

Silva-Perez

Benitez-Lopez

Varon

et al. 2017

WJD

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“…In this sense, Marik et al (62) have suggested adopting a therapeutic range of 140 to 200mg/dL for diabetic patients with HbA1c < 7% on admission and a therapeutic range of 160 to 220mg/dL in those with HbA1c > 7%; this appears to be appropriate based on the available information. (62) However, new clinical trials will be needed to validate these observations and to define whether or not a liberal glycemic control strategy is associated with better outcomes in critically ill diabetic patients with acute hyperglycemia.…”

Section: Introductionmentioning

confidence: 99%

Dysglycemia in the critically ill patient: current evidence and future perspectives

Aramendi¹,

Burghi²,

Manzanares³

2017

Revista Brasileira De Terapia Intensiva

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Dysglycemia in critically ill patients (hyperglycemia, hypoglycemia, glycemic variability and time in range) is a biomarker of disease severity and is associated with higher mortality. However, this impact appears to be weakened in patients with previous diabetes mellitus, particularly in those with poor premorbid glycemic control; this phenomenon has been called "diabetes paradox". This phenomenon determines that glycated hemoglobin (HbA1c) values should be considered in choosing glycemic control protocols on admission to an intensive care unit and that patients' target blood glucose ranges should be adjusted according to their HbA1c values. Therefore, HbA1c emerges as a simple tool that allows information that has therapeutic utility and prognostic value to be obtained in the intensive care unit.

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