One Size Doesn't Fit All! Revisiting Tight Control for Patients Without Diabetes

Major research efforts investigating “physiologic” glucose targets [e.g., 80-110 mg/dL / 4.4-6.1 mmol/L) have consistently revealed a marked increase in the risk of hypoglycemia and associated patient harm. While insulin therapeutic algorithms and improved glucose monitors and monitoring strategies have decreased this risk, it remains an overriding concern when considering application of physiologic glucose targets in the critically ill.  Crucially, however, in patients without chronic hyperglycemia or diabetes, even moderate levels of hyperglycemia have been associated with harm, including mortality.  Further, a quality outcome measure around hyperglycemia as a hospital-acquired condition has rekindled the discussion of glycemic endpoints.  Accordingly, there is continued interest in lower glucose targets in non-diabetic patients. Guidance will be offered towards consideration of this therapeutic strategy and how to potentially institute lower glucose goals safely in the critically ill, specifically addressing necessary technology and approaches required to consider broad application of this strategy.