Silva-Perez LJ, Benitez-Lopez MA, Varon J, Surani S. Management of critically ill patients with diabetes. World J Diabetes 2017; 8(3): 89-96 [PMID: 28344751 DOI: 10.4239/wjd.v8.i3.89]
Corresponding Author of This Article
Salim Surani, MD, MPH, MSHM, FACP, FCCP, FAASM, Department of Medicine, Texas A and M University, Corpus Christi, 1177 West Wheeler Ave, Suite 117, Aransas Pass, TX 78413, United States. srsurani@hotmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Minireviews
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. Mar 15, 2017; 8(3): 89-96 Published online Mar 15, 2017. doi: 10.4239/wjd.v8.i3.89
Management of critically ill patients with diabetes
Livier Josefina Silva-Perez, Mario Alberto Benitez-Lopez, Joseph Varon, Salim Surani
Livier Josefina Silva-Perez, Mario Alberto Benitez-Lopez, Department of Medicine, Autonomous University of Baja California, School of Medicine, Tijuana, BC 22260, Mexico
Joseph Varon, Department of Medicine, Foundation Surgical Hospital, the University of Texas Health Science Center at Houston, Houston, TX 77030, United States
Salim Surani, Department of Medicine, Texas A and M University, Corpus Christi, TX 78413, United States
Author contributions: Silva-Perez LJ and Benitez-Lopez MA was involved in writing, preparing figures and tables; Silva-Perez LJ and Benitez-Lopez MA contributed equally to this work; Surani S outlined and coordinated the writing of the paper; served as primary consultant for the paper, was the primary reviewer of the paper and added significant contributions to the text; Varon J provided input in writing the paper and made significant contributions to the text.
Conflict-of-interest statement: None of the authors have any conflict of interest to disclose as it regards to this manuscript.
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: Salim Surani, MD, MPH, MSHM, FACP, FCCP, FAASM, Department of Medicine, Texas A and M University, Corpus Christi, 1177 West Wheeler Ave, Suite 117, Aransas Pass, TX 78413, United States. srsurani@hotmail.com
Telephone: +1-361-8857722 Fax: +1-361-8507563
Received: August 27, 2016 Peer-review started: August 29, 2016 First decision: November 11, 2016 Revised: November 30, 2016 Accepted: December 27, 2016 Article in press: December 29, 2016 Published online: March 15, 2017 Processing time: 194 Days and 6 Hours
Abstract
Disorders of glucose homeostasis, such as stress-induced hypoglycemia and hyperglycemia, are common complications in patients in the intensive care unit. Patients with preexisting diabetes mellitus (DM) are more susceptible to hyperglycemia, as well as a higher risk from glucose overcorrection, that may results in severe hypoglycemia. In critically ill patients with DM, it is recommended to maintain a blood glucose range between 140-180 mg/dL. In neurological patients and surgical patients, tighter glycemic control (i.e., 110-140 mg/d) is recommended if hypoglycemia can be properly avoided. There is limited evidence that shows that critically ill diabetic patients with a glycosylated hemoglobin levels above 7% may benefit from looser glycemic control, in order to reduce the risk of hypoglycemia and significant glycemic variability.
Core tip: Diabetes mellitus is a common comorbidity found in critically ill patients. Although strict glycemic control in the past was considered a standard therapeutic intervention, newer clinical trials have shown that moderate glycemic control (i.e., glucose levels between 140-180 mg/dL) reduces mortality and morbidity in such patients.
