Improving glycemic control in critically ill patients: personalized care to mimic the endocrine pancreas.

J Geoffrey Chase, Thomas Desaive, Julien Bohe, Miriam Cnop, Christophe De Block, Jan Gunst, Roman Hovorka, Pierre Kalfon, James Krinsley, Eric Renard, Jean-Charles Preiser

Journal: Critical care (London, England) 2019;22(1):182

PMID: 30071851

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Abstract

There is considerable physiological and clinical evidence of harm and increased risk of death associated with dysglycemia in critical care. However, glycemic control (GC) currently leads to increased hypoglycemia, independently associated with a greater risk of death. Indeed, recent evidence suggests GC is difficult to safely and effectively achieve for all patients. In this review, leading experts in the field discuss this evidence and relevant data in diabetology, including the artificial pancreas, and suggest how safe, effective GC can be achieved in critically ill patients in ways seeking to mimic normal islet cell function. The review is structured around the specific clinical hurdles of: understanding the patient's metabolic state; designing GC to fit clinical practice, safety, efficacy, and workload; and the need for standardized metrics. These aspects are addressed by reviewing relevant recent advances in science and technology. Finally, we provide a set of concise recommendations to advance the safety, quality, consistency, and clinical uptake of GC in critical care. This review thus presents a roadmap toward better, more personalized metabolic care and improved patient outcomes.

Address: Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand.; GIGA In-Silico Medicine, University of Liège, Liège, Belgium.; Medical Intensive Care Unit, Lyon-Sud University Hospital, Pierre-Bénite, France.; ULB Center for Diabetes Research, and Division of Endocrinology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.; Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium.; Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.; University of Cambridge Metabolic Research Laboratories, Level 4, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.; Service de Réanimation polyvalente, Hôpital Louis Pasteur, CH de Chartres, Chartres, France.; Division of Critical Care, Department of Medicine, Stamford Hospital, Columbia University College of Physicians and Surgeons, Stamford, CT, USA.; Department of Endocrinology, Diabetes, Nutrition, and Institute of Functional Genomics, CNRS, INSERM, Montpellier University Hospital, University of Montpellier, Montpellier, France.; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, 1070, Brussels, Belgium. [email protected].

DOI: 10.1186/s13054-018-2110-1

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MeSH Terms: Critical Illness, Glycemic Load, Humans, Hyperglycemia, Hypoglycemia, Islets of Langerhans, Metabolism