Abstract
Tight glucose control in the intensive care unit was associated with an improved survival in one pioneering study, but this finding was not confirmed in seven other trials. The reasons underlying this discrepancy are not fully elucidated, indicating that an improved understanding of the physiology and pathophysiology of blood glucose (BG) regulation is needed. Potential reasons for the discrepancies between the studies also include: case-mix, with different optimal BG in different types of patients; hypoglycemia, which is associated with a poor outcome; and the magnitude of glucose variability. Safe and effective glucose control will require progress in the definition of optimal BG, and in the measurement techniques including continuous monitoring insulin algorithms and closed-loop systems.
Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.