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Review
. 2017 Jul-Sep;29(3):364-372.
doi: 10.5935/0103-507X.20170054.

Dysglycemia in the critically ill patient: current evidence and future perspectives

[Article in Spanish, English]
Ignacio Aramendi  1 , Gastón Burghi  1 , William Manzanares  2
Affiliations
Review

Dysglycemia in the critically ill patient: current evidence and future perspectives

[Article in Spanish, English]
Ignacio Aramendi et al. Rev Bras Ter Intensiva. 2017 Jul-Sep.

Abstract
in English, Spanish, Spanish

Dysglycemia in critically ill patients (hyperglycemia, hypoglycemia, glycemic variability and time in range) is a biomarker of disease severity and is associated with higher mortality. However, this impact appears to be weakened in patients with previous diabetes mellitus, particularly in those with poor premorbid glycemic control; this phenomenon has been called "diabetes paradox". This phenomenon determines that glycated hemoglobin (HbA1c) values should be considered in choosing glycemic control protocols on admission to an intensive care unit and that patients' target blood glucose ranges should be adjusted according to their HbA1c values. Therefore, HbA1c emerges as a simple tool that allows information that has therapeutic utility and prognostic value to be obtained in the intensive care unit.

RESUMEN La disglucemia en el paciente crítico (hiperglucemia, hipoglucemia, variabilidad de la glucemia y el tiempo en rango) es un marcador de severidad de la enfermedad crítica asociada a mayor mortalidad. Sin embargo, dicho impacto parece atenuarse en los pacientes con diabetes mellitus, en particular en aquellos con mal control glucémico premórbido lo cual ha sido denominado "paradoja de la diabetes". Este fenómeno determina que en los nuevos protocolos de control de la glucemia deban ser contemplados los valores de hemoglobina glucosilada (HbA1c) al ingreso a unidad de cuidados intensivos, siendo necesarios nuevos rangos de glucemia objetivos según los valores de la HbA1c. En tal sentido, la HbA1c surge como una herramienta sencilla que permite obtener información de utilidad terapéutica y valor pronóstico en la unidad de cuidados intensivos.

La disglucemia en el paciente crítico (hiperglucemia, hipoglucemia, variabilidad de la glucemia y el tiempo en rango) es un marcador de severidad de la enfermedad crítica asociada a mayor mortalidad. Sin embargo, dicho impacto parece atenuarse en los pacientes con diabetes mellitus, en particular en aquellos con mal control glucémico premórbido lo cual ha sido denominado "paradoja de la diabetes". Este fenómeno determina que en los nuevos protocolos de control de la glucemia deban ser contemplados los valores de hemoglobina glucosilada (HbA1c) al ingreso a unidad de cuidados intensivos, siendo necesarios nuevos rangos de glucemia objetivos según los valores de la HbA1c. En tal sentido, la HbA1c surge como una herramienta sencilla que permite obtener información de utilidad terapéutica y valor pronóstico en la unidad de cuidados intensivos.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Algorithm of target glycemic ranges in critical patients with hyperglycemia according to glycosylated hemoglobin at admission to an intensive care unit. HbA1c - glycosylated hemoglobin.
See this image and copyright information in PMC

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