• Hospital practice (1995) · Apr 2014

    Review

    Should guidelines for glycemic control of the critically ill be individualized?: Weighing the evidence from randomized and observational investigations.

    • James S Krinsley.
    • Director of Critical Care, Stamford Hospital, Stamford, CT; Clinical Professor of Medicine, Columbia University College of Physicians and Surgeons, New York, NY. jkrinsley@stamhealth.org.
    • Hosp Pract (1995). 2014 Apr 1; 42 (2): 14-22.

    AbstractThe monitoring of blood glucose and treatment of hyperglycemia has been a standard of care in intensive care units since the publication of a single-center randomized controlled trial (RCT) of intensive insulin therapy in 2001 that demonstrated marked improvements in mortality. Professional societies created guidelines based on the results of this investigation, and revised them based on the results of a very small group of RCTs that followed. This commentary reviews the weight of evidence provided by the RCTs in comparison to the large body of evidence from observational studies regarding glycemic control of the critically ill, and suggests that the totality of evidence should be considered in the formulation of clinical practice paradigms.

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