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Therapy Insight: the effect of tight glycemic control in acute illness

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 270–278 (2007)Cite this article

Abstract

Hyperglycemia commonly occurs in patients who are acutely ill, in a variety of clinical situations. Generally, moderate hyperglycemia in critically ill patients was thought to be beneficial; however, the degree of hyperglycemia on admission and the duration of hyperglycemia during critical illness are now recognized markers of adverse outcome. The use of insulin therapy to maintain normoglycemia for at least a few days improves survival and reduces morbidity in patients who are in a surgical intensive care unit (ICU), as shown by a large, randomized, controlled study. These results were recently confirmed by two studies—a randomized, controlled study of patients in a medical ICU, and a prospective, observational study of a heterogeneous patient population admitted to a mixed medical and surgical ICU. Results of multicenter trials that investigated tight blood-glucose control in critically ill patients are, however, still lacking. While we await those multicenter results, the current evidence favors the control of blood glucose levels in the ICU. Indeed, the studies showed that many lives are saved with this intervention, despite an increased incidence of hypoglycemia. Prevention of glucose toxicity by strict glycemic control (but also other metabolic and nonmetabolic effects of insulin) contribute to these clinical benefits.

Key Points

  • Hyperglycemia is common in acutely ill patients, diabetic or not, from a variety of different clinical settings

  • The upon-admission degree of hyperglycemia and the duration of hyperglycemia during critical illness have been increasingly recognized as markers of adverse outcome

  • Maintenance of normoglycemia with insulin therapy over at least a few days improves survival and reduces morbidity of patients in either surgical or medical intensive care units

  • Although the risk of hypoglycemia is increased with intensive insulin therapy, there is now evidence that brief hypoglycemia, diagnosed and treated promptly, does not cause early nor late mortality

  • The risk of hypoglycemia should not be used as a reason not to apply intensive insulin therapy

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Figure 1: Kaplan–Meier curves for in-hospital survival for the two Leuven studies1,12

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Acknowledgements

The work was supported by research grants from the Katholieke Universiteit Leuven and the Fund for Scientific Research. L Langouche and I Vanhorebeek are supported by the Fund for Scientific Research, Flanders, Belgium.

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Authors and Affiliations

  1. L Langouche and I Vanhorebeek are Postdoctoral Fellows, and G Van den Berghe is Professor of Medicine, at the Katholieke Universiteit Leuven, Belgium.,

    Lies Langouche, Ilse Vanhorebeek & Greet Van den Berghe

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  1. Lies Langouche
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  3. Greet Van den Berghe
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Correspondence to Greet Van den Berghe.

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Competing interests

G Van den Berghe holds an unrestrictive Katholieke Universiteit Leuven Novo Nordisk Chair of Research. The other authors declared they have no competing interests.

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Langouche, L., Vanhorebeek, I. & Van den Berghe, G. Therapy Insight: the effect of tight glycemic control in acute illness. Nat Rev Endocrinol 3, 270–278 (2007). https://doi.org/10.1038/ncpendmet0426

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