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World J Diabetes. Oct 15, 2021; 12(10): 1719-1730
Published online Oct 15, 2021. doi: 10.4239/wjd.v12.i10.1719
Glycemic targets in critically ill adults: A mini-review
Kay Choong See
Kay Choong See, Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore
Author contributions: See KC collected the data and wrote the paper; See KC read and approved the final manuscript.
Conflict-of-interest statement: See KC has received honoraria from GE Healthcare and Medtronic, and has no other conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kay Choong See, FCCP, FRCP, MBBS, MRCP, Doctor, Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hos-pital, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228, Singapore. mdcskc@nus.edu.sg
Received: April 3, 2021
Peer-review started: April 3, 2021
First decision: June 5, 2021
Revised: June 6, 2021
Accepted: September 3, 2021
Article in press: September 3, 2021
Published online: October 15, 2021
Processing time: 192 Days and 16.9 Hours
Abstract

Illness-induced hyperglycemia impairs neutrophil function, increases pro-inflammatory cytokines, inhibits fibrinolysis, and promotes cellular damage. In turn, these mechanisms lead to pneumonia and surgical site infections, prolonged mechanical ventilation, prolonged hospitalization, and increased mortality. For optimal glucose control, blood glucose measurements need to be done accurately, frequently, and promptly. When choosing glycemic targets, one should keep the glycemic variability < 4 mmol/L and avoid targeting a lower limit of blood glucose < 4.4 mmol/L. The upper limit of blood glucose should be set according to casemix and the quality of glucose control. A lower glycemic target range (i.e., blood glucose 4.5-7.8 mmol/L) would be favored for patients without diabetes mellitus, with traumatic brain injury, or who are at risk of surgical site infection. To avoid harm from hypoglycemia, strict adherence to glycemic control protocols and timely glucose measurements are required. In contrast, a higher glycemic target range (i.e., blood glucose 7.8-10 mmol/L) would be favored as a default choice for medical-surgical patients and patients with diabetes mellitus. These targets may be modified if technical advances for blood glucose measurement and control can be achieved.

Keywords: Brain injuries; Traumatic; Critical care; Diabetes mellitus; Glycemic control; Insulin infusion systems; Sepsis

Core Tip: A lower glycemic target range (i.e., blood glucose 4.5-7.8 mmol/L) would be favored for patients without diabetes mellitus, or with traumatic brain injury, or who are postoperative and at risk of surgical site infection. Requirements for targeting a lower range and avoiding hypoglycemia would be availability of intensive glucose monitoring and management, strict adherence to glycemic control protocols, and strict adherence to timely glucose measurements. In contrast, a higher glycemic target range (i.e., blood glucose 7.8-10 mmol/L) would be favored as a default choice for medical-surgical patients and patients with diabetes mellitus.