Hyperglycemia is associated with increased morbidity and mortality in critically ill patients and requires treatment; however, hypoglycemia is also detrimental to patients and must be avoided. Maintaining blood glucose between 140 - 180 mg/dL for critically ill patients improves outcomes. Very frequent glucose monitoring and adjustment of intravenous insulin infusion remains the standard of care to reach blood glucose goals but is also labor intensive. Emerging technology for continuous glucose monitoring that may include notifications or automated communication with an insulin delivery system may improve the maintenance of blood glucose in range and avoid hypoglycemia and hyperglycemia.
Kavanaugh, B.P. and McCowen, K.C. (2010) Glycemic Control in the ICU. The New England Journal of Medicine, 363, 2540-2546. https://doi.org/10.1056/NEJMcp1001115
Moghissi, E.S., Korytkowski, M.T., DiNardo, M., Einhorn, D., Hellman, R., Hirsch, I.B., Inzucchi, S.E., Ismail-Beigi, F., Kirkman, M.S. and Umpierrez, G.E. (2009) American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control. Diabetes Care, 32, 1119-1131. https://doi.org/10.2337/dc09-9029
Dombrowski, N.C. and Karounos, D.G. (2013) Pathophysiology and Management Strategies for Hyperglycemia for Patients with Acute Illness during and Following a Hospital Stay. Metabolism, 62, 326-336. https://doi.org/10.1016/j.metabol.2012.07.020
Dziedzic, T., Slowik, A., Pera, J. and Szczudlik, A. (2009) Association between Hyperglycemia, Heart Failure, and Mortality in Stroke Patients. European Journal of Neurology, 16, 251-256. https://doi.org/10.1111/j.1468-1331.2008.02400.x
Moghissi, E.S., Korytkowski, M.T., DiNardo, M., Einhorn, D., Hellman, R., Hirsch, I.B., Inzucchi, S.E., Ismail-Beigi, F., Kirkman, M.S. and Umpierrez, G.E. (2009) American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control. Endocrine Practice, 15, 353-369. https://doi.org/10.4158/EP09102.RA
Falciglia, M., Freyburg, R.W., Almenoff, P.L., D’Alessio, D.A. and Render, M.L. (2009) Hyperglycemia-Related Mortality in Critically Ill Patients Varies with Admission Diagnosis. Critical Care Medicine, 37, 3001-3009. https://doi.org/10.1097/CCM.0b013e3181b083f7
Laird, A.M., Miller, P.R., Kilgo, P.D., Meredith, J.W. and Change, M.C. (2004) Relationship of Early Hyperglycemia to Mortality in Trauma Patients. The Journal of Trauma, 56, 1058-1062. https://doi.org/10.1097/01.TA.0000123267.39011.9F
Krinsley, J.S. (2003) Association between Hyperglycemia and Increased Hospital Mortality in a Heterogeneous Population of Critically Ill Patients. Mayo Clinic Proceedings, 78, 1471-1478. https://doi.org/10.4065/78.12.1471
Marfella, R., Siniscalchi, M., Esposito, K., Sellitto, A., De Fanis, U., Romano, C., Portoghese, M., Siciliano, S., Nappo, F., Sasso, F.C. and Mininni, N. (2003) Effects of Stress Hyperglycemia on Acute Myocardial Infarction: Role of Inflammatory Immune Process in Functional Cardiac Outcome. Diabetes Care, 26, 3129-3135. https://doi.org/10.2337/diacare.26.11.3129
Dungan, K.M., Braithwaite, S.S. and Preiser, J.C. (2009) Stress Hyperglycemia. The Lancet, 373, 1798-1807. https://doi.org/10.1016/S0140-6736(09)60553-5
Saand, A.R., Flores, M., Kewan, T., Alqaisi, S., Alwakeel, M., Griffiths, L., Wang, X., Han, X., Burton, R., Al-Jaghbeer, M.J. and Fadel, F.A. (2021) Does Inpatient Hyperglycemia Predict Worse Outcomes in COVID-19 Intensive Care Unit Patients? Journal of Diabetes, 13, 253-260. https://doi.org/10.1111/1753-0407.13137
Godinjak, A., Iglica, A., Burekovic, A., Jusufovic, S., Ajanovic, A., Tancica, I. and Kukuljac, A. (2015) Hyperglycemia in Critically Ill Patients: Management and Prognosis. Medical Archives, 69, 157-160. https://doi.org/10.5455/medarh.2015.69.157-160
Handelsman, Y., Bloomgarden, Z.T., Grunberger, G., Umpierrez, G., Zimmerman, R.S., Bailey, T.S., Blonde, L., Bray, G.A., Cohen, A.J., Dagogo-Jack, S., Davidson, J.A., Einhorn, D., Ganda, O.P., Garber, A.J., Garvey, W.T., Henry, R.R., Hirsch, I.B., Horton, E.S., Hurley, D.L., Jellinger, P.S., Jovanovič, L., Lebovitz, H.E., LeRoith, D., Levy, P., McGill, J.B., Mechanick, J.I., Mestman, J.H., Moghissi, E.S., Orzeck, E.A., Pessah-Pollack, R., Rosenblit, P.D., Vinik, A.I., Wyne, K. and Zangeneh, F. (2015) American Association of Clinical Endocrinologists and American College of Endocrinology-Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan—2015. Endocrine Practice, 21, 1-87. https://doi.org/10.4158/EP15672.GLSUPPL
American Diabetes Association (2021) 15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2021. Diabetes Care, 44, S211-S220. https://doi.org/10.2337/dc21-S015
Jacobi, J., Bircher, N., Krinsley, J., Agus, M., Braithwaite, S.S., Deutschman, C., Freire, A.X., Geehan, D., Kohl, B., Nasraway, S.A., Rigby, M., Sands, K., Schallom, L., Taylor, B., Umpierrez, G., Mazuski, J. and Schunemann, H. (2012) Guidelines for the Use of an Insulin Infusion for the Management of Hyperglycemia in Critically Ill Patients. Critical Care Medicine, 40, 3251-3276. https://doi.org/10.1097/CCM.0b013e3182653269
Roberts, G.W., Aguilar-Loza, N., Esterman, A., Burt, M.G. and Stranks, S.N. (2012) Basal-Bolus Insulin versus Sliding-Scale Insulin for Inpatient Glycaemic Control: A Clinical Practice Comparison. The Medical Journal of Australia, 194, 266-269. https://doi.org/10.5694/mja11.10853
Perez, A., Ramos, A. and Carreras, G. (2020) Insulin Therapy in Hospitalized Patients. American Journal of Therapeutics, 27, e71-e78. https://doi.org/10.1097/MJT.0000000000001078
Duggan, E.W., Carlson, K. and Umpierrez, G.E. (2017) Perioperative Hyperglycemia Management: An Update. Anesthesiology, 126, 547-560. https://doi.org/10.1097/ALN.0000000000001515
Bilotta, F., Badenas, R., Lolli, S., Belda, F.J., Einav, S. and Rosa, G. (2015) Insulin Infusion Therapy in Critical Care Patients: Regular Insulin vs. Short-Acting Insulin. A Prospective, Crossover, Randomized, Multicenter Blind Study. Journal of Critical Care, 30, 437.e1-6. https://doi.org/10.1016/j.jcrc.2014.10.019
Masood, M.Q., Batool, S., Banu, S. and Hussain, E. (2021) Efficacy and Safety of a New Insulin Infusion Protocol Adapted for the Target Glycemic Range of 140-180 mg/dl in Adult Critical Care Units: A Tertiary Care Centre Experience. International Journal of Diabetes in Developing Countries, 41, 469-475. https://doi.org/10.1007/s13410-020-00915-3
Van den Berghe, G., Wouters, P., Weekers, F., Verwaest, C., Bruyninckx, F., Schetz, M., Vlasselaers, D., Ferdinande, P., Lauwers, P. and Bouillon, R. (2001) Intensive Insulin Therapy in Critically Ill Patients. The New England Journal of Medicine, 345, 1359-1367. https://doi.org/10.1056/NEJMoa011300
Van den Berghe, G., Wilmer, A., Hermans, G., Meersseman, W., Wouters, P.J., Milants, I., Van Wijngaerden, E., Bobbaers, H. and Bouillon, R. (2006) Intensive Insulin Therapy in the Medical ICU. The New England Journal of Medicine, 354, 449-461. https://doi.org/10.1056/NEJMoa052521
American Diabetes Association (2008) Standards of Medical Care in Diabetes—2008. Diabetes Care, 31, S12-S54. https://doi.org/10.2337/dc08-S012
The NICE-SUGAR Study Investigators (2009) Intensive versus Conventional Glucose Control in Critically Ill Patients. The New England Journal of Medicine, 360, 1283-1297. https://doi.org/10.1056/NEJMoa0810625
Griesdale, D.E.G., de Souza, R.J., van Dam, R.M., Daren, K., Heyland, D.K., Cook, D.J., Malhotra, A., Dhaliwal, R., Henderson, W.R., Chittock, D.R., Finfer, S. and Talmor, D. (2009) Intensive Insulin Therapy and Mortality among Critically Ill Patients: A Meta-Analysis Including NICE-SUGAR Study Data. The Canadian Medical Association Journal, 180, 821-827. https://doi.org/10.1503/cmaj.090206
The NICE-SUGAR Study Investigators (2012) Hypoglycemia and Risk of Death in Critically Ill Patients. The New England Journal of Medicine, 367, 1108-1118. https://doi.org/10.1056/NEJMoa1204942
The NICE-SUGAR Study Investigators (2015) Intensive versus Conventional Glucose Control in Critically Ill Patients with Traumatic Brain Injury: Long-Term Follow-Up of a Subgroup of Patients from the NICE-SUGAR Study. Intensive Care Medicine, 41, 1037-1047. https://doi.org/10.1007/s00134-015-3757-6
Krinsley, J.S. (2015) Glycemic Control in the Critically Ill: What Have We Learned since NICE-SUGAR? Hospital Practice, 43, 191-197. https://doi.org/10.1080/21548331.2015.1066227
Galindo, R.J., Umpierrez, G.E., Rushakoff, R.J., Basu, A., Lohnes, S., Nichols, J.H., Spanakis, E.K., Espinoza, J., Palermo, N.E., Awadjie, D.G., Bak, L., Buckingham, B., Cook, C.B., Freckmann, G., Heinemann, L., Hovorka, R., Mathioudakis, N., Newman, T., O’Neal, D.N., Rickert, M., Sacks, D.B., Seley, J.J., Wallia, A., Shang, T., Zhang, J.Y., Han, J. and Klonoff, D.C. (2020) Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline. Journal of Diabetes Science and Technology, 14, 1035-1064. https://doi.org/10.1177/1932296820954163
Lu, M., Zuo, Y., Guo, J., Wen, X. and Kang, Y. (2018) Continuous Glucose Monitoring System Can Improve the Quality of Glucose Control and Glucose Variability Compared with Point-of-Care Measurement in Critically Ill Patients: A Randomized Controlled Trial. Medicine (Baltimore), 97, e12138. https://doi.org/10.1097/MD.0000000000012138
Boom, D.T., Sechterberger, M.K., Rijkenberg, S., Kreder, S., Bosman, R.J., Wester, J.P., van Stijn, I., DeVries, J.H. and van der Voort, P.H. (2014) Insulin Treatment Guided by Subcutaneous Continuous Glucose Monitoring Compared to Frequent Point-of-Care Measurement in Critically Ill Patients: A Randomized Controlled Trial. Critical Care, 18, Article No. 453. https://doi.org/10.1186/s13054-014-0453-9
Tanenberg, R.J., Hardee, S., Rothermel, C. and Drake, A.J. (2017) Use of a Computer-Guided Glucose Management System to Improve Glycemic Control and Address National Quality Measures: A 7-Year Retrospective Observational Study at a Tertiary Care Teaching Hospital. Endocrine Practice, 23, 331-341. https://doi.org/10.4158/EP161402.OR
Dubois, J., Van Herpe, T., van Hooijdonk, R.T., Wouters, R., Coart, D., Wouters, P., Van Assche, A., Veraghtert, G., De Moor, B., Wauters, J., Wilmer, A., Schultz, M.J., Van den Berghe, G. and Mesotten, D. (2017) Software-Guided versus Nurse-Directed Blood Glucose Control in Critically Ill Patients: The LOGIC-2 Multicenter Randomized Controlled Clinical Trial. Critical Care, 21, Article No. 212. https://doi.org/10.1186/s13054-017-1799-6
Hashemi, N., Valk, T., Houlind, K. and Ejskjaer, N. (2019) Insulin-Based Infusion System: Advancing the Development. Journal of Diabetes Science and Technology, 13, 941-948. https://doi.org/10.1177/1932296819832876
Umpierrez, G.E., Hellman, R., Korytkowski, M.T., Kosiborod, M., Maynard, G.A., Montori, V.M., Seley, J.J., Van den Berghe, G. and Endocrine Society (2012) Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 97, 16-38. https://doi.org/10.1210/jc.2011-2098
Avanzini, F., Marelli, G., Donzelli, W., Busi, G., Carbone, S., Bellato, L., Colombo, E.L., Foschi, R., Riva, E., Roncaglioni, M.C., De Martini, M. and Desio Diabetes Diagram Study Group (2011) Transition from Intravenous to Subcutaneous Insulin. Diabetes Care, 34, 1445-1450. https://doi.org/10.2337/dc10-2023
Doolin, M.K., Walroth, T.A., Harris, S.A., Whitten, J.A. and Fritschle-Hilliard, A.C. (2016) Transition from Intravenous to Subcutaneous Insulin in Critically Ill Adults. Journal of Diabetes Science and Technology, 10, 932-938. https://doi.org/10.1177/1932296816629985