A liberal glycemic target in critically ill patients with poorly controlled diabetes?

Due to severe physical stress, critically ill patients commonly develop hyperglycemia. Multiple observational studies have shown a U-shaped association between glycemic levels in the intensive care unit (ICU) and the risk of death, with the lowest risk of death associated with glucose levels that are normal for age (1-3). Three landmark randomized controlled trials (RCTs) performed in Leuven and several subsequent single-center studies found that treating pronounced hyperglycemia [>215 mg/dL (11.9 mmol/L)] with insulin to target age-adjusted normoglycemia [80–110 mg/dL (4.4–6.1 mmol/L) for adults, 60–100 mg/dL (3.9–5.6 mmol/L) for children, 50–80 mg/dL (2.8–4.4 mmol/L) for infants] reduced morbidity and mortality for both critically ill adults and children (4-8).