Skip to main content
Erschienen in: Diabetologia 6/2008

01.06.2008 | For Debate

No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l

verfasst von: J. M. Miles, M. M. McMahon, W. L. Isley

Erschienen in: Diabetologia | Ausgabe 6/2008

Einloggen, um Zugang zu erhalten

Excerpt

Over the past 10 years, a number of studies have been published suggesting that an intensified approach to glycaemic control in hospitalised patients, using intravenous insulin infusion, results in improved outcomes, including decreased mortality rate. These observations have resulted in dramatic changes in the management of hospital hyperglycaemia in Europe and in North America. In the present issue of Diabetologia, Van den Berghe recommends a blood glucose target of 4.4–6.1 mmol/l for patients in the intensive care unit (ICU) [1], a position endorsed at a consensus conference convened by the American College of Endocrinology and co-sponsored by the American Diabetes Association, the American Heart Association, the Endocrine Society, the Society of Critical Care Medicine and several other organisations [2]. For reasons outlined in this paper, we believe that the available data are insufficient to warrant such a recommendation. …
Literatur
1.
Zurück zum Zitat Van den Berghe G (2007) Insulin therapy in the intensive care unit should be targeted to maintain blood glucose between 4.4 mmol/l and 6.1 mmol/l. Diabetologia DOI 10.1007/s00125-007-0878-7 Van den Berghe G (2007) Insulin therapy in the intensive care unit should be targeted to maintain blood glucose between 4.4 mmol/l and 6.1 mmol/l. Diabetologia DOI 10.​1007/​s00125-007-0878-7
2.
Zurück zum Zitat Anonymous (2004) ACE position statement. Endocr Pract 10:5–9 Anonymous (2004) ACE position statement. Endocr Pract 10:5–9
3.
Zurück zum Zitat Van den Berghe G, Wouters P, Weekers F et al (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345:1359–1367PubMedCrossRef Van den Berghe G, Wouters P, Weekers F et al (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345:1359–1367PubMedCrossRef
4.
Zurück zum Zitat Malmberg K (1997) Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ 314:1512–1515PubMed Malmberg K (1997) Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ 314:1512–1515PubMed
5.
Zurück zum Zitat Furnary AP, Gao G, Grunkemeier GL et al (2003) Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 125:1007–1021PubMedCrossRef Furnary AP, Gao G, Grunkemeier GL et al (2003) Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 125:1007–1021PubMedCrossRef
6.
Zurück zum Zitat Krinsley JS (2004) Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 79:992–1000PubMed Krinsley JS (2004) Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 79:992–1000PubMed
7.
Zurück zum Zitat Van den Berghe G, Wilmer A, Hermans G et al (2006) Intensive insulin therapy in the medical ICU. N Engl J Med 354:449–461PubMedCrossRef Van den Berghe G, Wilmer A, Hermans G et al (2006) Intensive insulin therapy in the medical ICU. N Engl J Med 354:449–461PubMedCrossRef
8.
Zurück zum Zitat Klein CJ, Stanek GS, Wiles CE 3rd (1998) Overfeeding macronutrients to critically ill adults: metabolic complications. J Am Diet Assoc 98:795–806PubMedCrossRef Klein CJ, Stanek GS, Wiles CE 3rd (1998) Overfeeding macronutrients to critically ill adults: metabolic complications. J Am Diet Assoc 98:795–806PubMedCrossRef
9.
Zurück zum Zitat Anonymous (1991) Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. N Engl J Med 325:525–532CrossRef Anonymous (1991) Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. N Engl J Med 325:525–532CrossRef
10.
Zurück zum Zitat Klein S, Kinney J, Jeejeebhoy K, Alpers D et al (1997) Nutrition support in clinical practice: review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. Am J Clin Nutr 66:683–706PubMed Klein S, Kinney J, Jeejeebhoy K, Alpers D et al (1997) Nutrition support in clinical practice: review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. Am J Clin Nutr 66:683–706PubMed
11.
Zurück zum Zitat Braunschweig CL, Levy P, Sheean PM, Wang X (2001) Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr 74:534–542PubMed Braunschweig CL, Levy P, Sheean PM, Wang X (2001) Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr 74:534–542PubMed
12.
Zurück zum Zitat Sax HC, Warner BW, Talamini MA et al (1987) Early total parenteral nutrition in acute pancreatitis: lack of beneficial effects. Am J Surg 153:117–124PubMedCrossRef Sax HC, Warner BW, Talamini MA et al (1987) Early total parenteral nutrition in acute pancreatitis: lack of beneficial effects. Am J Surg 153:117–124PubMedCrossRef
13.
Zurück zum Zitat Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE (2002) Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 87:978–982PubMedCrossRef Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE (2002) Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 87:978–982PubMedCrossRef
14.
Zurück zum Zitat McMahon MM, Bistrian BR (1995) Host defenses and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am 9:1–9PubMed McMahon MM, Bistrian BR (1995) Host defenses and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am 9:1–9PubMed
15.
Zurück zum Zitat Bagdade JD, Root RK, Bulger RJ (1974) Impaired leukocyte function in patients with poorly controlled diabetes. Diabetes 23:9–15PubMed Bagdade JD, Root RK, Bulger RJ (1974) Impaired leukocyte function in patients with poorly controlled diabetes. Diabetes 23:9–15PubMed
16.
Zurück zum Zitat Mesotten D, Swinnen JV, Vanderhoydonc F, Wouters PJ, Van den Berghe G (2004) Contribution of circulating lipids to the improved outcome of critical illness by glycemic control with intensive insulin therapy. J Clin Endocrinol Metab 89:219–226PubMedCrossRef Mesotten D, Swinnen JV, Vanderhoydonc F, Wouters PJ, Van den Berghe G (2004) Contribution of circulating lipids to the improved outcome of critical illness by glycemic control with intensive insulin therapy. J Clin Endocrinol Metab 89:219–226PubMedCrossRef
17.
Zurück zum Zitat Albrink MJ, Krauss RM, Lindgrem FT, von der Groeben J, Pan S, Wood PD (1980) Intercorrelations among plasma high density lipoprotein, obesity and triglycerides in a normal population. Lipids 15:668–676PubMedCrossRef Albrink MJ, Krauss RM, Lindgrem FT, von der Groeben J, Pan S, Wood PD (1980) Intercorrelations among plasma high density lipoprotein, obesity and triglycerides in a normal population. Lipids 15:668–676PubMedCrossRef
18.
Zurück zum Zitat Battistella FD, Widergren JT, Anderson JT, Siepler JK, Weber JC, MacColl K (1997) A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition. J Trauma 43:52–58PubMed Battistella FD, Widergren JT, Anderson JT, Siepler JK, Weber JC, MacColl K (1997) A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition. J Trauma 43:52–58PubMed
19.
Zurück zum Zitat Miles JM (1991) Intravenous fat emulsions in nutritional support. Curr Opin Gastroenterol 7:306–311 Miles JM (1991) Intravenous fat emulsions in nutritional support. Curr Opin Gastroenterol 7:306–311
20.
Zurück zum Zitat Freeman J, Goldmann DA, Smith NE, Sidebottom DG, Epstein MF, Platt R (1990) Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units. N Engl J Med 325:301–308CrossRef Freeman J, Goldmann DA, Smith NE, Sidebottom DG, Epstein MF, Platt R (1990) Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units. N Engl J Med 325:301–308CrossRef
21.
Zurück zum Zitat Seidner DL, Mascioli EA, Istfan NW et al (1989) Effects of long-chain triglyceride emulsions on reticuloendothelial system function in humans. J Parenter Enteral Nutr 13:614–619CrossRef Seidner DL, Mascioli EA, Istfan NW et al (1989) Effects of long-chain triglyceride emulsions on reticuloendothelial system function in humans. J Parenter Enteral Nutr 13:614–619CrossRef
22.
Zurück zum Zitat Jensen MD, Caruso M, Heiling VJ, Miles JM (1989) Insulin regulation of lipolysis in nondiabetic and IDDM subjects. Diabetes 38:1595–1601PubMedCrossRef Jensen MD, Caruso M, Heiling VJ, Miles JM (1989) Insulin regulation of lipolysis in nondiabetic and IDDM subjects. Diabetes 38:1595–1601PubMedCrossRef
23.
Zurück zum Zitat Korvald C, Elvenes OP, Myrmel T (2000) Myocardial substrate metabolism influences left ventricular energetics in vivo. Am J Physiol 278:H1345–H1351 Korvald C, Elvenes OP, Myrmel T (2000) Myocardial substrate metabolism influences left ventricular energetics in vivo. Am J Physiol 278:H1345–H1351
24.
Zurück zum Zitat Steinberg HO, Tarshoby M, Monestel R et al (1997) Elevated circulating free fatty acid levels impair endothelium-dependent vasodilation. J Clin Invest 100:1230–1239PubMedCrossRef Steinberg HO, Tarshoby M, Monestel R et al (1997) Elevated circulating free fatty acid levels impair endothelium-dependent vasodilation. J Clin Invest 100:1230–1239PubMedCrossRef
25.
Zurück zum Zitat Stojiljkovic MP, Zhang D, Lopes HF, Lee CG, Goodfriend TL, Egan BM (2001) Hemodynamic effects of lipids in humans. Am J Physiol 280:R1674–R1679 Stojiljkovic MP, Zhang D, Lopes HF, Lee CG, Goodfriend TL, Egan BM (2001) Hemodynamic effects of lipids in humans. Am J Physiol 280:R1674–R1679
26.
Zurück zum Zitat Van den Berghe G, Wouters PJ, Bouillon R et al (2003) Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose vs glycemic control. Crit Care Med 31:359–366PubMedCrossRef Van den Berghe G, Wouters PJ, Bouillon R et al (2003) Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose vs glycemic control. Crit Care Med 31:359–366PubMedCrossRef
27.
Zurück zum Zitat Miles JM (2006) Energy expenditure in hospitalized patients: implications for nutritional support. Mayo Clin Proc 81:809–816PubMed Miles JM (2006) Energy expenditure in hospitalized patients: implications for nutritional support. Mayo Clin Proc 81:809–816PubMed
28.
Zurück zum Zitat Cerra FB, Benitez MR, Blackburn GL et al (1997) Applied nutrition in ICU patients. A consensus statement of the American College of Chest Physicians. Chest 111:769–778PubMedCrossRef Cerra FB, Benitez MR, Blackburn GL et al (1997) Applied nutrition in ICU patients. A consensus statement of the American College of Chest Physicians. Chest 111:769–778PubMedCrossRef
29.
Zurück zum Zitat Cryer PE (2006) Hypoglycaemia: the limiting factor in the glycaemic management of the critically ill? Diabetologia 49:1722–1725PubMedCrossRef Cryer PE (2006) Hypoglycaemia: the limiting factor in the glycaemic management of the critically ill? Diabetologia 49:1722–1725PubMedCrossRef
Metadaten
Titel
No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l
verfasst von
J. M. Miles
M. M. McMahon
W. L. Isley
Publikationsdatum
01.06.2008
Verlag
Springer-Verlag
Erschienen in
Diabetologia / Ausgabe 6/2008
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-007-0888-5

Weitere Artikel der Ausgabe 6/2008

Diabetologia 6/2008 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Reizdarmsyndrom: Diäten wirksamer als Medikamente

29.04.2024 Reizdarmsyndrom Nachrichten

Bei Reizdarmsyndrom scheinen Diäten, wie etwa die FODMAP-arme oder die kohlenhydratreduzierte Ernährung, effektiver als eine medikamentöse Therapie zu sein. Das hat eine Studie aus Schweden ergeben, die die drei Therapieoptionen im direkten Vergleich analysierte.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.