Kar P, Jones KL, Horowitz M, Deane AM. Management of critically ill patients with type 2 diabetes: The need for personalised therapy. World J Diabetes 2015; 6(5): 693-706 [PMID: 26069718 DOI: 10.4239/wjd.v6.i5.693]
Corresponding Author of This Article
Dr. Palash Kar, Intensive Care Unit, Level 4, Emergency Services Building, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia. p_kar@hotmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Diabetes. Jun 10, 2015; 6(5): 693-706 Published online Jun 10, 2015. doi: 10.4239/wjd.v6.i5.693
Management of critically ill patients with type 2 diabetes: The need for personalised therapy
Palash Kar, Karen L Jones, Michael Horowitz, Adam M Deane
Palash Kar, Adam M Deane, Discipline of Acute Care Medicine, Level 5, Eleanor Harrald Building, University of Adelaide, South Australia 5000, Australia
Palash Kar, Adam M Deane, Intensive Care Unit, Level 4, Emergency Services Building, Royal Adelaide Hospital, South Australia 5000, Australia
Karen L Jones, Michael Horowitz, Adam M Deane, Centre for Research Excellence, University of Adelaide, South Australia 5000, Australia
Karen L Jones, Michael Horowitz, Discipline of Medicine, Level 6, Eleanor Harrald Building, University of Adelaide, South Australia 5000, Australia
Author contributions: Kar P was involved in conception and design of manuscript, acquiring and interpretation of data and drafting and revising the manuscript for final submission; Jones KL and Horowitz M co-supervised Kar P and were involved in conception, design and coordination of the manuscript along with drafting and revising the manuscript; Deane AM supervised Kar P, and was involved in conception and design of manuscript, acquiring data, analysis and interpretation of data, and drafting and revising the manuscript for final submission; all authors read and approved the final manuscript.
Conflict-of-interest: The authors declare there are no non-financial competing interests. Horowitz M has participated in advisory boards and/or symposia for Novo/Nordisk, Sanofi-aventis, Novartis, Eli-Lily, Boehringer Ingelheim, AstraZeneca, Satlogen and Meyer Nutraceuticals.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Dr. Palash Kar, Intensive Care Unit, Level 4, Emergency Services Building, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia. p_kar@hotmail.com
Telephone: +61-8-82224624
Received: December 24, 2014 Peer-review started: December 26, 2014 First decision: February 7, 2015 Revised: February 20, 2015 Accepted: April 1, 2015 Article in press: April 7, 2015 Published online: June 10, 2015 Processing time: 176 Days and 21.2 Hours
Abstract
Critical illness in patients with pre-existing diabetes frequently causes deterioration in glycaemic control. Despite the prevalence of diabetes in patients admitted to hospital and intensive care units, the ideal management of hyperglycaemia in these groups is uncertain. There are data that suggest that acute hyperglycaemia in critically ill patients without diabetes is associated with increased mortality and morbidity. Exogenous insulin to keep blood glucose concentrations < 10 mmol/L is accepted as standard of care in this group. However, preliminary data have recently been reported that suggest that chronic hyperglycaemia may result in conditioning, which protects these patients against damage mediated by acute hyperglycaemia. Furthermore, acute glucose-lowering to < 10 mmol/L in patients with diabetes with inadequate glycaemic control prior to their critical illness appears to have the capacity to cause harm. This review focuses on glycaemic control in critically ill patients with type 2 diabetes, the potential for harm from glucose-lowering and the rationale for personalised therapy.
Core tip: With diabetes increasing in prevalence, the optimal management of glycaemia in critically ill patients with pre-existing diabetes remains unknown. Recent data has highlighted therapeutic uncertainties specific to these patients with suggestions that targeted blood glucose concentrations may benefit from consideration of a patient’s premorbid glucose state. In patients with uncontrolled type 2 diabetes, it may be safer to target blood glucose concentrations between 10-14 mmol/L, however definitive studies of critically ill patients with poorly controlled diabetes are required. In contrast, in patients with CIAH, or those with well-controlled diabetes (HbA1c < 7.0) have data supporting a more conservative target (6-10 mmol/L).
