Blood glucose control in the intensive care unit: differentiated values for people with and without diabetes make sense
When adjusting and monitoring the blood glucose of patients in the intensive care unit, it can be useful to differentiate between people with and without diabetes. The authors Andreas Birkenfeld, DZD spokesperson and Medical Director of the Department of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, and Christian von Loeffelholz, University Hospital Jena, point this out in an opinion article in the journal "Lancet D&E". They underline the importance of personalized therapies for intensive care patients with diabetes, but also point to the need for further detailed data and studies.
Stress-induced hyperglycemia, hypoglycemia and diabetes often occur in critically ill patients. To avoid complications, insulin therapy is recommended for persistent blood glucose levels above 10.0 mmol/L, with a target range of 7.8-10-0 mmol/L. Recent randomized controlled clinical trials challenge these recommendations and show that there are differences in risk assessment and blood glucose management between ICU patients with and without diabetes. Stricter targets may apply to certain patient groups. Current recommendations support blood glucose targets of 6.1-7.8 mmol/L. It is important to consider individual differences and to monitor blood glucose levels carefully to find a balance between strict targets and avoidance of hypoglycemia. Computerized algorithms for blood glucose management and innovative technologies such as continuous glucose monitoring could help.
The authors emphasize the importance of personalized therapies for ICU patients with diabetes, as individual risk profiles and blood glucose tolerances can vary. For example, observational studies indicate an increased mortality rate with liberal glucose control in patients with an HbA1c uptake of less than 6.5%. This could indicate the existence of subgroups of people with diabetes who could benefit from stricter blood glucose targets. In intensive care patients with diabetes, a pre-hospital HbA1c value of at least 8% could be considered an indication of an increased risk of relative hypoglycemia.
The authors emphasize the need for further research to find out which subgroups of patients could benefit from stricter blood glucose limits. It is also important to further investigate gender-specific differences in blood glucose limits in ICU patients and the possible effects of the female menstrual cycle on blood glucose levels.
In an era of technological, bioinformatics and therapeutic advances and the increasing importance of precise strategies, it is important to test new approaches to create better treatment options for all intensive care patients. The authors call on all stakeholders to work together towards this important goal.
Original-Publication:
Christian von Loeffelholz , Andreas L Birkenfeld 2024: Tight versus liberal blood-glucose control in the intensive care unit: special considerations for patients with diabetes. The Lancet Diabetes and Endocrinology. DOI: 10.1016/S2213-8587(24)00058-5
Scientific Contact:
Prof. Dr. med. Andreas Birkenfeld
Telefon: 07071 29-82735
E-Mail: andreas.birkenfeld@med.uni-tuebingen.de
Link to the paper
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