• Ilse Vanhorebeek, Lies Langouche, and Greet Van den Berghe.
• Department of Intensive Care Medicine, Katholieke Universiteit, Leuven, Leuven, Belgium.
• Endocr Pract. 2006 Jul 1;12 Suppl 3:14-22.

ObjectiveHyperglycemia is a common feature of the critically ill and has been associated with increased mortality. In this review, we give an overview of studies associating critical illness-induced hyperglycemia with adverse outcome and describe how mortality and morbidity are affected when blood glucose levels are strictly controlled to normoglycemia with intensive insulin therapy.ResultsMaintaining normoglycemia with intensive insulin therapy improves survival rates and reduces morbidity in prolonged critically ill patients in both surgical and medical intensive care units (ICUs), as shown by 2 large randomized controlled studies. Prevention of cellular glucose toxicity by strict glycemic control appears to play a predominant role, but other metabolic and nonmetabolic effects of insulin also seem to contribute to the clinical benefits of this therapy.ConclusionThese data support the generalized implementation of a strict blood glucose control management with intensive insulin therapy in adult surgical as well as medical ICU patients.

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