Glycemic targets in critically ill adults: A mini-review

Table 2 Glycemic targets in intensive care unit by casemix and thresholds

Casemix	Blood sample	Method	Glycemic target	Evidence
Burns	Not stated	Not stated	Glucose > 7.8 mmol/L	Increased pneumonia, ventilator-associated pneumonia, and urinary tract infection; Obs[72]
Cardiac	Not stated	Not stated	Glucose 4.4-6.1 mmol/L	Decreased 30-d mortality compared to glucose 5-7.8 mmol/L; Obs[73]
DM	Not stated	Portable glucometer, blood gas analyzer	Glucose < 14 mmol/L	Decreased glycemic variability and incident hypoglycemia; before-and-after study[35]
DM	Arterial, venous	Blood gas analyzer	Glucose 10-14 mmol/L	Decreased incident hypoglycemia; before-and-after study[74]. No increased risk of hospital-acquired infectious, cardiovascular, renal or neurological complications; before-and-after study[75]
DM	Not stated	Portable glucometer	Glucose 5.6-7.8 mmol/L	Decreased complications (infection, cardiac events, respiratory failure, kidney failure) after coronary artery bypass graft surgery compared to glucose 7.8-10 mmol/L; RCT[34]
DM	Not stated	Portable glucometer	Glucose 5-7.8 mmol/L	Decreased 30-day mortality compared to glucose 4.4-6.1 mmol/L; Obs[76]
Medical	Capillary	Portable glucometer	Glucose > 7 mmol/L	Increased ICU mortality; Obs[77]
Medical-surgical	Arterial	Point-of-care or blood gas or laboratory analyzers	Glucose 8-10 mmol/L	Decreased 90-d mortality and incident severe hypoglycemia compared to glucose 4.5-6.0 mmol/L; RCT[31]
Medical-surgical	Not stated	Portable glucometer	Glucose 4.4-6.1 mmol/L	Decreased 30-d mortality compared to glucose 5-7.8 mmol/L in patients without DM; Obs[76]
Medical-surgical	Arterial	Point-of-care or blood gas or laboratory analyzers	Glucose 4.4-6.1 mmol/L	Increased incident severe hypoglycemia compared to more liberal control (95%CI of glucose -7.8-9.4) mmol/L; RCT[78]
Medical-surgical	Arterial, capillary	Glucometer	Glucose 10-11.1 mmol/L	Decreased incident severe hypoglycemia compared to glucose 4.4-6.1 mmol/L; RCT[46]
Medical-surgical	Arterial, capillary, venous	Glucometer or blood gas analyzer	Glucose 7.8-10 mmol/L	Decreased incident severe hypoglycemia compared to glucose 4.4-6.1 mmol/L; RCT[79]
Medical-surgical	Arterial	Portable glucometer	Glucose 7-9 mmol/L	Decreased ICU mortality compared to out-of-range glucose; Obs[80]
Medical-surgical	Arterial, capillary	Glucometer or blood gas analyzer	Glucose < 10 mmol/L	Decreased incident severe hypoglycemia compared to glucose 4.4-6.1 mmol/L; RCT[31,81]
Medical-surgical	Arterial	Glucometer	Glucose < 8 mmol/L	Decreased ICU mortality compared to higher glucose levels; Obs[82]
Medical-surgical	Arterial	Blood gas analyzer	Glucose > 8.3 mmol/L	Increased ICU mortality compared to glucose 6.1-8.3; Obs[83]
Medical-surgical	Arterial, capillary	Glucometer	Glucose < 8.2 mmol/L	Decreased ICU mortality compared to higher glucose levels; Obs[84]
Medical-surgical	Arterial, venous	Glucometer	Glucose 4.4-7.8 mmol/L	Decreased ICU and hospital mortality compared to glucose 7.8-10 mmol/L in patients without DM; Obs[26]
Medical-surgical	Not stated	Glucometer	Glucose 3.9-7.8 mmol/L	Time in range associated with decreased ICU mortality in patients without DM; Obs[85]; Time in range associated with decreased ICU mortality in patients receiving insulin; Obs[86]
Medical-surgical	Venous	Laboratory	Low SHR < 1	Decreased hospital mortality compared to SHR > 1 regardless of baseline HbA1c; Obs[87]
Post-CA	Capillary, venous	Not stated	Glucose 3.9-7.8 mmol/L	Higher survival, compared to higher glucose levels; Obs[88]
Post-CA	Not stated	Not stated	Glucose 4-10 mmol/L	Better neurological recovery, compared to higher glucose levels; Obs[33]
Surgical	Arterial	Blood gas analyzer	Glucose 4.4-6.1 mmol/L	Decreased hospital mortality, blood stream infections, acute renal failure, blood transfusion, critical-illness polyneuropathy, prolonged mechanical ventilation, compared to glucose 10-11.1 mmol/L; RCT[42]
Surgical	Not stated	Not stated	Glucose 4.4-6.1 mmol/L	Decreased post-operative renal failure and 30-d mortality compared to glucose > 8.3 mmol/L; Obs[89]
Surgical	Arterial, capillary, venous	Glucometer or blood gas analyzer	Glucose 4.4-7.8 mmol/L	Decreased hospital mortality compared to glucose >7.8 mmol/L; Obs[27]
Surgical	Not stated	Glucometer	Glucose 4-8 mmol/L	Decreased surgical site infection after coronary artery bypass graft surgery compared to glucose 4-10 mmol/L; before-and-after study[28]
Surgical	Arterial, venous	Continuous sensor, in a closed-loop system	Glucose 4.4-6.1 mmol/L	Decreased surgical site infection post- hepato-biliary-pancreatic surgery, compared to glucose 7.7-10.0 mmol/L; RCT[90]
Surgical	Arterial	Blood gas analyzer	Glucose 6.7-8.9 mmol/L	Decreased mortality compared to glucose 8.9-10 mmol/L; quasi-experimental (alternate allocation of participants)[91]
Surgical	Capillary	Glucometer	Glucose 6.1-8.3 mmol/L	Decreased surgical site infection and atrial fibrillation after coronary artery bypass graft surgery; before-and-after study[29]
TBI	Arterial	Blood gas analyzer	Glucose 3.5-6.5 mmol/L	Reduced intracranial hypertension and decreased rate of pneumonia, bacteremia and urinary tract infections during 2nd week, compared to glucose 5-8 mmol/L; Obs[5]
TBI	Not stated	Not stated	Glucose 4.4-6.7 mmol/L	Decreased risk of poor neurological outcomes but increased risk of hypoglycemia, and no mortality benefit, compared to higher glucose targets; systematic review of RCT[30]
TBI	Arterial	Point-of-care or blood gas or laboratory analyzers	Glucose 8-10 mmol/L	Decreased incident severe hypoglycemia, but no mortality benefit, compared to glucose 4.5-6.0 mmol/L; RCT[92]
TBI	Not stated	Not stated	Glucose < 11.1 mmol/L	Decreased hospital mortality compared to glucose > 11.1 mmol/L; Obs[93]
Trauma	Arterial, capillary, venous	Point-of-care or laboratory analyzers	Glucose < 7.8 mmol/L	Decreased ICU mortality compared to glucose > 7.8 mmol/L; Obs[94]
Trauma	Capillary	Not stated	Glucose < 10 mmol/L	Decreased hospital mortality compared to glucose > 10 mmol/L; Obs[32]

DM: Diabetes mellitus; HbA1c: Glycosylated hemoglobin; ICU: Intensive care unit; Obs: Observational study; RCT: Randomized controlled trial; SHR: Stress hyperglycemia ratio; TBI: Traumatic brain injury.