Advances in Glucose Monitoring and Insulin Therapy in Intensive Care Unit Patients.

Kim,  Tae Nyun

doi:2018.19.4.224

J Korean Diabetes > Volume 19(4); 2018 > Article

Focused Issue

The Journal of Korean Diabetes 2018;19(4):224-231.
DOI: https://doi.org/10.4093/jkd.2018.19.4.224 Published online January 8, 2019.

중환자실 환자의 혈당 모니터링과 인슐린 치료

김태년

Advances in Glucose Monitoring and Insulin Therapy in Intensive Care Unit Patients.

Tae Nyun Kim

¹Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University College of Medicine, Busan, Korea. kimtn031@gmail.com
²Cardiovascular and Metabolic Disease Center, Inje University College of Medicine, Busan, Korea.

Abstract

Since the multicenter Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation (NICE-SUGAR) study was published, the pursuit of tight glycemic control (TGC) among intensive care unit (ICU) patients has been seen as counterproductive and moderate glycemic control has become standard practice in ICUs. However, thus far, there is good evidence that hypoglycemia and hyperglycemia are associated with worse outcomes in ICU patients. Recently, the importance of improving time in band and reducing hypoglycemic episodes and glycemic variability has been more recognized. Compared to intermittent monitoring systems, continuous glucose monitoring (CGM) can have greater clinical benefit in terms of the prevention of severe hyperglycemia and hypoglycemia by enabling insulin infusions to be adjusted more rapidly and accurately. In this review, modern methods for glucose control in the ICU are presented, as well as future perspectives including the development of CGM and semiautomated glucose control, such as closed-loop systems.

Key Words: Glucose, Hyperglycemia, Hypoglycemia, Insulin, Intensive care units