Hyperglycemia Management in Critical Units and End-Stage Hospitalized Patients
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 15 No. 03 (2025),
22 September 2025
,
Page 1-6
https://doi.org/10.22037/ijmtfm.v15i03.49676
Abstract
Background: Hospitalized patients frequently experience hyperglycemia, and numerous studies have demonstrated a substantial correlation between the risk of complications and hyperglycemia, extended hospital stays, and mortality for both diabetic and nondiabetic patients. The significance of hyperglycemia extends to patients with non-critical illness, as previous research has demonstrated that glucose control in the intensive care unit improves clinical outcomes by lowering the risk of multi-organ failure, systemic infection, and death. For the mainstream of adult patients with critical illness, stringent blood glucose control has been advised based on some previous observational and interventional investigations.
Methods: A comprehensive search of the literature was performed, followed by screening and eligibility assessment of the retrieved studies. Relevant data were then extracted and synthesized systematically. Finally, the manuscript was prepared through structured scientific writing.
Results: However, the recently randomized controlled studies have demonstrated that assertive glycemic control, contrasting to traditional control, which targets high blood glucose levels, may not enhance clinical results and is associated with a high risk of hypoglycemia. For most intensive care unit (ICU) hyperglycemic patients, the American Diabetes Association (ADA) recommends a glucose level of 140–180 mg/dL after medication is started in 2025.
Conclusion: Research shows that planned subcutaneous insulin (basal, nutritional, and correctional) is favored over sliding-scale insulin alone in non-ICU settings; intravenous insulin is the norm for patients in the critical care unit.
- Hospital
How to Cite
References
Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes research and clinical practice. 2022;183:109119. [DOI: 10.1016/j.diabres.2021.109119]
Dhatariya K, James J, Kong MF, Berrington R, Group JBDSfIC, group gw. Diabetes at the front door. A guideline for dealing with glucose related emergencies at the time of acute hospital admission from the Joint British Diabetes Society (JBDS) for Inpatient Care Group. Diabetic Medicine. 2020;37(9):1578-89. [DOI: 0.1111/dme.14304]
Jiang HJ, Stryer D, Friedman B, Andrews R. Multiple hospitalizations for patients with diabetes. Diabetes care. 2003;26(5):1421-6. [DOI: 10.1111/dme.14304]
Donnan PT, Leese GP, Morris AD, Audit D, Research in Tayside SMMUC. Hospitalizations for people with type 1 and type 2 diabetes compared with the nondiabetic population of Tayside, Scotland: a retrospective cohort study of resource use. Diabetes care. 2000;23(12):1774-9. [DOI: 10.2337/diacare.23.12.1774]
Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. The Journal of Clinical Endocrinology & Metabolism. 2002;87(3):978-82. [DOI: 10.1210/jcem.87.3.8341]
Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, et al. 2022 National standards for diabetes self-management education and support. The science of diabetes self-management and care. 2022;48(1):44-59. [DOI: 10.1177/26350106211072203]
Report NDS. Available from https://www.cdc.gov/diabetes/php/data-research/index.html. 2024. [Link]
Parker ED, Lin J, Mahoney T, Ume N, Yang G, Gabbay RA, et al. Economic costs of diabetes in the US in 2022. Diabetes care. 2024;47(1):26-43. [DOI: 10.2337/dci23 0085]
Van Den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. New England journal of medicine. 2001;345(19):1359-67. [DOI: 10.1056/NEJMoa011300]
Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. New England journal of medicine. 2006;354(5):449-61. [DOI: 10.1056/NEJMoa052521]
Investigators N-SS. Intensive versus conventional glucose control in critically ill patients. New England Journal of Medicine. 2009;360(13):1283-97. [DOI: 10.1056/NEJMoa0810625]
Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. New England Journal of Medicine. 2008;358(2):125-39. [DOI: 10.1056/NEJMoa070716]
Preiser J-C, Devos P, Ruiz-Santana S, Mélot C, Annane D, Groeneveld J, et al. A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive care medicine. 2009;35:1738-48. [DOI: 10.1007/s00134 009 1585 2]
Krinsley JS, Deane AM, Gunst J. The goal of personalized glucose control in the critically ill remains elusive. Intensive Care Medicine. 2021;47(11):1319-21. [DOI: 10.1007/s00134-021-06530-y]
Vlasselaers D, Milants I, Desmet L, Wouters PJ, Vanhorebeek I, van den Heuvel I, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. The Lancet. 2009;373(9663):547-56. [DOI: 10.1016/S0140-6736(09)60044-1]
Macrae D, Grieve R, Allen E, Sadique Z, Morris K, Pappachan J, et al. A randomized trial of hyperglycemic control in pediatric intensive care. New England Journal of Medicine. 2014;370(2):107-18. [DOI: 10.1056/NEJMoa1302564]
Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes care. 2009;32(6):1119. [DOI: 10.2337/dc09-9029]
Pérez A, Ramos A, Carreras G. Insulin therapy in hospitalized patients. American journal of therapeutics. 2020;27(1):e71-e8. [DOI: 10.1097/MJT.0000000000001078]
Kosiborod MN, Angermann CE, Collins SP, Teerlink JR, Ponikowski P, Biegus J, et al. Effects of empagliflozin on symptoms, physical limitations, and quality of life in patients hospitalized for acute heart failure: results from the EMPULSE trial. Circulation. 2022;146(4):279-88. [DOI: 10.1161/CIRCULATIONAHA.122.059725]
Wilson T, Singh AP, Vorsa N, Goettl CD, Kittleson KM, Roe CM, et al. Human glycemic response and phenolic content of unsweetened cranberry juice. Journal of Medicinal Food. 2008;11(1):46-54. [DOI: 10.1089/jmf.2007.531]
Inman T. Foundation for a new theory and practice of medicine: John Churchill, New Burlington Street; 1860. [Link]
Diabetes U. End of life diabetes care. https://diabetes-resources-production s3 eu-west-1 amazonaws com/resources-s3/2018-03/EoL_Guidance_2018_Final pdf Accessed. 2012;6:11-8.
James J. Dying well with diabetes. Annals of palliative medicine. 2019;8(2):17889-189. [DOI: 10.21037/apm.2018.12.10]
Association AD. Economic costs of diabetes in the US in 2017. Diabetes Care. 2018;41(5):917-28.
Care JBDSI. Group. The management of diabetic ketoacidosis in adults. Update. 2013. [DOI: 10.2337/dci18-0007]
Scott A, Care JBDSfI, Group JHHG. Management of hyperosmolar hyperglycaemic state in adults with diabetes. Diabetic Medicine. 2015;32(6):714-24. [DOI: 10.1111/dme.12757]
- Abstract Viewed: 104 times
- PDF Downloaded: 52 times