Hyperglycemia should be Avoided in Critical Illness and the Postoperative Period

Recent evidence from large clinical trials has cast into doubt the benefit of intensive insulin therapy to control hyperglycemia in the critically ill, and has in some instances shown harm from attempts to aggressively lower blood glucose. We argue that adverse results are linked to the occurrence of hypoglycemia, a problem made worse by excessively ambitious glucose targets in the context of an inappropriate definition of hypoglycemia (≤2.2 mmol/L) and methodology for point-of-care testing of blood glucose that lacks precision and accuracy. With an appropriate glucose target and careful avoidance of hypoglycemia, intensive therapy is safe and likely to benefit critically ill patients with hyperglycemia. We endorse the ADA/AACE current recommended glucose target range of 7.8-10.0 mmol/L