CHEST Guidelines-Is-It-Time-to-Rethink-Blood-Glucose-Targets-in-Cri

Is-It-Time-to-Rethink-Blood-Glucose-Targets-in-Cri

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The past debate over optimal blood glucose (BG) targets for critically ill patients, especially after the 2009 NICE-SUGAR trial, has reemerged with recent findings by Hersh et al. The NICE-SUGAR trial suggested that intensive insulin therapy with a BG target of 80 to 110 mg/dL led to higher mortality compared to a more moderate target of 140 to 180 mg/dL, influencing global clinical guidelines to favor less strict glycemic control. However, Hersh et al. reported improved mortality in cardiac patients managed with a tighter BG range of 80 to 110 mg/dL compared to a slightly higher range of 90 to 140 mg/dL, albeit influenced by confounders and the study's observational design.<br /><br />The discussion highlights that hypoglycemia and the time patients spend in the targeted BG range significantly impact outcomes. Achieving safe and effective glucose control requires frequent BG monitoring and practice. One critical insight is that BG management may need to be tailored according to patient profiles rather than adopting a one-size-fits-all approach, as glycemic needs vary between conditions (e.g., surgery vs. pneumonia).<br /><br />Additionally, preadmission glycemic status plays a role in outcomes; patients with diabetes might respond differently to intensive glycemic control. Evidence suggests personalized targets: tighter control for non-diabetics and well-managed diabetics, and adjusted targets for poorly controlled diabetics.<br /><br />The study by Hersh et al. and others question whether the current moderate BG targets should be reassessed, advocating for protocols that consider individual risks, patient profiles, and ensure frequent BG measurements to safely achieve optimal glycemic control. This nuanced approach could bridge the gap between achieving mortality benefits without increasing risks like hypoglycemia.

Keywords

blood glucose targets

critically ill patients

NICE-SUGAR trial

intensive insulin therapy

glycemic control

Hersh et al.

hypoglycemia

personalized treatment

diabetes management

mortality outcomes