Glycemic Control in Critically Ill Patients

Glycemic control in critically ill patients encompasses the monitoring and regulation of blood glucose levels to mitigate the risks of both hyperglycaemia and hypoglycaemia. Acute illness induces stress-related hormonal and inflammatory responses that disrupt normal glucose metabolism, often resulting in transient hyperglycaemia even in individuals without pre-existing diabetes. Conversely, overly aggressive insulin therapy may precipitate hypoglycaemia, which is independently associated with adverse outcomes. Recent work has highlighted that not only sustained elevations in mean glucose but also rapid fluctuations between high and low values—commonly termed glycaemic variability—contribute to organ dysfunction and mortality. The optimal therapeutic window for blood glucose remains a subject of debate, with evidence suggesting that moderate targets may strike a balance between avoiding the harms of severe hyperglycaemia and the dangers of insulin-induced hypoglycaemia. Continuous or near-continuous glucose monitoring technologies are emerging to support more responsive and personalised insulin delivery, enabling clinicians to adapt targets according to individual patient factors such as diabetic status, severity of illness and risk of neurological injury. Ultimately, a nuanced approach that combines real-time data, predictive modelling and patient-specific protocols aims to improve survival rates, reduce the incidence of secondary complications and standardise best practice across diverse critical care environments.

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Glycemic Control in Critically Ill Patients publication trend

The graph below shows the total number of articles in glycemic control in critically ill patients across all publications each year (not limited to Nature Index journals).

Technical terms

Stress hyperglycaemia ratio (SHR): The quotient of current blood glucose to estimated chronic glucose, used to quantify acute glycaemic perturbation relative to baseline control.

Glycaemic variability: The magnitude and frequency of fluctuations in blood glucose over time, reflecting instability beyond mean glucose levels.

Time in range (TIR): The proportion of a monitoring period during which blood glucose remains within a specified target band.

Continuous glucose monitoring (CGM): A technology that provides near-real-time measurements of interstitial glucose, facilitating timely detection of dysglycaemia and guiding therapy.

References

1. Association between the stress hyperglycemia ratio and 28-day all-cause mortality in critically ill patients with sepsis: a retrospective cohort study and predictive model establishment based on machine learning. Cardiovascular Diabetology (2024).
2. Time in blood glucose range 70 to 140 mg/dl >80% is strongly associated with increased survival in non-diabetic critically ill adults. Critical Care (2015).
3. Continuous glucose monitoring in the ICU: clinical considerations and consensus. Critical Care (2017).
4. The impact of early hypoglycemia and blood glucose variability on outcome in critical illness. Critical Care (2009).
5. Mild hypoglycemia is independently associated with increased mortality in the critically ill. Critical Care (2011).
6. Stress hyperglycemia: an essential survival response!. Critical Care (2013).