Abstract
Hyperglycemia is a common feature of the critically ill in general and of patients with sepsis in particular. Even a moderate degree of hyperglycemia appears detrimental for the outcome of critically ill patients, since maintenance of normoglycemia (blood glucose levels 110 mg/dL) with intensive insulin therapy has shown to improve survival and reduce morbidity in prolonged critically ill patients in both surgical and medical intensive care units, as revealed by two large randomized controlled studies. Subsequently, questions have been raised regarding the efficacy and safety of this intervention, above all in the major subpopulation of intensive care patients presenting with sepsis, who are particularly susceptible to hypoglycemia as well. Adequately powered and executed randomized controlled trials addressing explicitly the impact of hyperglycemia, tight blood glucose control and the inherently increased risk of hypoglycemia on mortality and morbidity in patients with sepsis are presently lacking. However, the available literature suggests a causal link between hyperglycemia and adverse outcome in sepsis and a benefit of intensive insulin therapy in sepsis equal to the benefit found in critical illness without sepsis and critical illness in general. Though a high frequency of hypoglycemia may be noted during insulin treatment of patients with sepsis, the present observations define hypoglycemia as a marker of disease severity rather than a harmful treatment side-effect. Prevention of cellular glucose toxicity by strict glycemic control appears to play a predominant role, but other metabolic and nonmetabolic, anti-inflammatory effects of insulin seem to contribute to the clinical benefits realized.
Keywords: Critical illness, sepsis, hyperglycemia, hypoglycemia, tight glycemic control, insulin, mortality, morbidity
Current Pharmaceutical Design
Title: Glucose Metabolism and Insulin Resistance in Sepsis
Volume: 14 Issue: 19
Author(s): S. J. Van Cromphaut, I. Vanhorebeek and G. Van den Berghe
Affiliation:
Keywords: Critical illness, sepsis, hyperglycemia, hypoglycemia, tight glycemic control, insulin, mortality, morbidity
Abstract: Hyperglycemia is a common feature of the critically ill in general and of patients with sepsis in particular. Even a moderate degree of hyperglycemia appears detrimental for the outcome of critically ill patients, since maintenance of normoglycemia (blood glucose levels 110 mg/dL) with intensive insulin therapy has shown to improve survival and reduce morbidity in prolonged critically ill patients in both surgical and medical intensive care units, as revealed by two large randomized controlled studies. Subsequently, questions have been raised regarding the efficacy and safety of this intervention, above all in the major subpopulation of intensive care patients presenting with sepsis, who are particularly susceptible to hypoglycemia as well. Adequately powered and executed randomized controlled trials addressing explicitly the impact of hyperglycemia, tight blood glucose control and the inherently increased risk of hypoglycemia on mortality and morbidity in patients with sepsis are presently lacking. However, the available literature suggests a causal link between hyperglycemia and adverse outcome in sepsis and a benefit of intensive insulin therapy in sepsis equal to the benefit found in critical illness without sepsis and critical illness in general. Though a high frequency of hypoglycemia may be noted during insulin treatment of patients with sepsis, the present observations define hypoglycemia as a marker of disease severity rather than a harmful treatment side-effect. Prevention of cellular glucose toxicity by strict glycemic control appears to play a predominant role, but other metabolic and nonmetabolic, anti-inflammatory effects of insulin seem to contribute to the clinical benefits realized.
Export Options
About this article
Cite this article as:
Van Cromphaut J. S., Vanhorebeek I. and Berghe Van den G., Glucose Metabolism and Insulin Resistance in Sepsis, Current Pharmaceutical Design 2008; 14 (19) . https://dx.doi.org/10.2174/138161208784980563
DOI https://dx.doi.org/10.2174/138161208784980563 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Somatic Drugs for Psychiatric Diseases: Aspirin or Simvastatin for Depression?
Current Neuropharmacology Simvastatin and Other HMG-CoA Reductase Inhibitors on Brain Cholesterol Levels in Alzheimers Disease
Current Alzheimer Research Recent Patents on Imaging Nanoprobes for Brain Tumor Diagnosis and Therapy
Recent Patents on Biotechnology The Endocannabinoid System in Ageing: A New Target for Drug Development
Current Drug Targets Inhalable Nanostructures for Lung Cancer Treatment: Progress and Challenges
Current Nanomedicine Vitamins in the Prevention or Delay of Cognitive Disability of Aging
Current Aging Science Melanoma
Current Cancer Therapy Reviews The Immunomodulatory Effects of Physical Activity
Current Pharmaceutical Design Innovative Cancer Treatments that Augment Radiotherapy or Chemotherapy by the Use of Immunotherapy or Gene Therapy
Recent Patents on Anti-Cancer Drug Discovery Hypoxia and Oxidative Stress in the Causation of Diabetic Retinopathy
Current Diabetes Reviews Sudden Infant Death Following Hexavalent Vaccination: A Neuropathologic Study
Current Medicinal Chemistry In Vivo Cellular Imaging for Translational Medical Research
Current Medical Imaging Novel Target Identification Technologies for the Personalised Therapy of Type II Diabetes and Obesity
Immunology, Endocrine & Metabolic Agents in Medicinal Chemistry (Discontinued) Minocycline Repurposing in Critical Illness: Focus on Stroke
Current Topics in Medicinal Chemistry Experimental and Clinical Application of Plasmid DNA in the Field of Central Nervous Diseases
Current Gene Therapy The Role of Oxazolidine Derivatives in the Treatment of Infectious and Chronic Diseases
Current Bioactive Compounds Statin Treatment Non-adherence and Discontinuation: Clinical Implications and Potential Solutions
Current Pharmaceutical Design Cerebral Microemboli Increase β-amyloid Protein Deposition, MMP-9, and GFAP Expression in the Alzheimer`s Model of APP/PS1 Double Transgenic Mice
Current Neurovascular Research Biological and Pharmacological Activities of Iridoids: Recent Developments
Mini-Reviews in Medicinal Chemistry Role of Nitric Oxide and Reactive Oxygen Species in Arthritis
Current Pharmaceutical Design