Glucose: the worst of all evils?

Abstract

The acute phase response is associated with metabolic derangements, including hyperglycaemia. Hyperglycaemia is associated with adverse clinical outcomes, including increased morbidity and mortality in various patient populations. The obvious question is: does tight blood glucose control improve morbidity and mortality in critically ill patients? Tight glycaemic control (TGC) or intensive insulin therapy (IIT) has become a major area of research, debate and controversies. The belief that hyperglycaemia is a physiological response and intervention is only warranted when the renal threshold is exceeded rapidly changed to aggressive control and, currently, clinical practice is moving to a mid-point between the two.