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Curr Opin Clin Nutr Metab Care · Mar 2012
ReviewThe impact of premorbid diabetic status on the relationship between the three domains of glycemic control and mortality in critically ill patients.
- James S Krinsley, Geert Meyfroidt, Greet van den Berghe, Mori Egi, and Rinaldo Bellomo.
- Division of Critical Care, Stamford Hospital, Columbia University College of Physicians and Surgeons, Stamford, Connecticut 06902, USA. jkrinsley@stamhealth.org
- Curr Opin Clin Nutr Metab Care. 2012 Mar 1;15(2):151-60.
Purpose Of ReviewHyperglycemia, hypoglycemia and increased glycemic variability are independently associated with increased risk of mortality in critically ill patients. The purpose of this review is to evaluate the evidence from interventional trials of intensive insulin therapy, as well as observational cohort studies, relating premorbid diabetic status and these three domains of glycemic control to mortality.Recent FindingsHyperglycemia has a stronger association with mortality in critically ill patients without diabetes than in those with diabetes. Hypoglycemia is independently associated with increased risk of mortality in both populations. Limited data suggest that increased glycemic variability may have a stronger association with mortality in patients without diabetes than in those with diabetes.SummaryPremorbid diabetic status impacts the relationship of the three domains of glycemic control to risk of mortality in critically ill patients. The data presented in this review are hypothesis generating; future trials of IIT in the critically ill should stratify management and outcomes by premorbid diabetic status.
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