Glycemic Targets for the Critically Ill Patient.

Kim,  Hyun Min; Kim,  Jaetaek

doi:2015.16.1.18

J Korean Diabetes > Volume 16(1); 2015 > Article

Focused Issue

The Journal of Korean Diabetes 2015;16(1):18-24.
DOI: https://doi.org/10.4093/jkd.2015.16.1.18 Published online March 26, 2015.

중환자에서의 혈당 조절의 목표

김현민, 김재택

Glycemic Targets for the Critically Ill Patient.

Hyun Min Kim, Jaetaek Kim

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea. jtkim@cau.ac.kr

Abstract

Critically ill patients often experience hyperglycemia, which may be associated with increased morbidity and mortality. In 2001, van den Berghe et al. suggested significant benefit of normalization of blood glucose level in critically ill patients using intensive intravenous insulin therapy. Subsequent multicenter randomized studies, however, demonstrated adverse effects of tight glucose control. Therefore, while the need for glucose control in critically ill patients is generally accepted, the treatment thresholds for initiation of insulin therapy or target glucose values are still undetermined. Furthermore, occurrence of a hypoglycemic event during intensive insulin therapy is known to be an independent predictor of clinical outcome, and glycemic variability is an important variable of glucose management in the critically ill patients. Novel technological approaches such as a continuous glucose monitoring system (CGMS) might help to overcome some problems of tight glucose control by reducing the risk of hypoglycemia and minimizing glycemic variability.

Key Words: Critical illness, Hyperglycemia, Intensive care units