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02-26-2018 | Hyperglycemia | Review | Article

Critical Care Management of Stress-Induced Hyperglycemia

Journal: Current Diabetes Reports

Authors: Ilse Vanhorebeek, Jan Gunst, Greet Van den Berghe

Publisher: Springer US


Purpose of Review

We discuss key studies that have set the scene for the debate on the efficacy and safety of tight glycemic control in critically ill patients, highlighting important differences among them, and describe the ensuing search towards strategies for safer glucose control.

Recent Findings

Differences in level of glycemic control, glucose measurement and insulin administration, expertise, and nutritional management may explain the divergent outcomes of the landmark studies on tight glycemic control in critical illness. Regarding strategies towards safer glucose control, several computerized algorithms have shown promise, but lack validation in adequately powered outcome studies. Real-time continuous glucose monitoring and closed loop blood glucose control systems are not up to the task yet due to technical challenges, though recent advances are promising. Alternatives for insulin have only been investigated in small feasibility studies.


Severe hyperglycemia in critically ill patients generally is not tolerated anymore, but the optimal blood glucose target may depend on the specific patient and logistic context.
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Novel clinical evidence in continuous glucose monitoring

Novel clinical evidence in continuous glucose monitoring

How real-world studies complement randomized controlled trials

Jean-Pierre Riveline uses data from real-life continuous glucose monitoring studies to illustrate how these can uncover critical information about clinical outcomes that are hard to assess in randomized controlled trials.

This video has been developed through unrestricted educational funding from Abbott Diabetes Care.

Watch the video