Academic Journal
View in EDS

Individualising blood glucose control in ICU patients: evidence and practical implementations.

Bibliographic Details
Title: Individualising blood glucose control in ICU patients: evidence and practical implementations.
Authors: Gunst J; Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. jan.gunst@kuleuven.be.; Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium. jan.gunst@kuleuven.be., Krinsley JS; Department of Medicine, Stamford Hospital, Stamford, CT, USA., Lanspa MJ; Intermountain Medical Center, Salt Lake City, UT, USA., Preiser JC; Department of Internal Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium., Singer M; Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK., Van den Berghe G; Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.; Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium.
Source: Critical care (London, England) [Crit Care] 2026 Sep 09; Vol. 30 (1). Date of Electronic Publication: 2026 Sep 09.
Publication Type: Journal Article; Review
Language: English
Journal Info: Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 9801902 Publication Model: Electronic Cited Medium: Internet ISSN: 1466-609X (Electronic) Linking ISSN: 13648535 NLM ISO Abbreviation: Crit Care Subsets: MEDLINE
Imprint Name(s): Publication: London, UK : BioMed Central Ltd
Original Publication: London : Current Science Ltd, c1997-
MeSH Terms: Intensive Care Units*/organization & administration , Blood Glucose*/metabolism , Blood Glucose*/analysis , Blood Glucose*/drug effects , Hyperglycemia*/prevention & control , Hyperglycemia*/drug therapy , Glycemic Control*/methods , Glycemic Control*/standards, Hypoglycemia/prevention & control ; Critical Illness/therapy ; Hypoglycemic Agents/therapeutic use ; Insulin/therapeutic use ; Humans ; Randomized Controlled Trials as Topic
Abstract: Many intensive care unit patients develop hyperglycaemia, and this is associated with an increased risk of adverse outcomes. Landmark randomised controlled trials (RCTs) suggest the impact of lowering blood glucose to the healthy, age-adjusted fasting range, hereafter called tight glucose control, depends on the accuracy of the glucose control protocol and the nutritional strategy. In the context of early parenteral nutrition, a condition that induces severe, iatrogenic hyperglycaemia, tight glucose control significantly reduced morbidity and mortality compared to tolerating severe hyperglycaemia. In the absence of early parenteral nutrition, hyperglycaemia was less severe; tight glucose control, applied with a computerised protocol that avoided severe hypoglycaemia, did not impact mortality nor the duration of ICU dependency as primary endpoint in a large multicentre RCT, but was associated with a less pronounced benefit on selected morbidity outcomes. Conversely, tight glucose control, using a protocol that considerably increased the risk of severe hypoglycaemic events, concomitantly increased mortality; nevertheless, the cause of excess mortality in this trial remains unproven and other mechanisms may have contributed as well. Altogether, evidence suggests that severe and iatrogenic hyperglycaemia and hypoglycaemia should both be avoided. From a pathophysiologic point of view, tight glucose control may be superior in selected settings if it can be applied with a validated protocol that avoids severe hypoglycaemia. In the absence of such a protocol, the increased risk of severe hypoglycaemia may offset any benefit of preventing hyperglycaemia, and tolerating intermediate blood glucose targets is likely the default setting. In the paper, we suggest specific blood glucose targets that differ according to the clinical context. Future research should aim at strategies that further optimise the quality of blood glucose control and study whether these improve patient-centred outcomes, and investigate whether specific patient populations benefit from individualised targets.
(© 2026. The Author(s).)
Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable Consent for publication: Not applicable Competing interests: JCP reports non-financial support of clinical research from Dexcom. JG, JSK, MJL, MS and GVdB report no competing interests.
References: Curr Opin Crit Care. 2019 Aug;25(4):356-362. (PMID: 31107308)
Nat Rev Endocrinol. 2026 Jun;22(6):369-380. (PMID: 41491727)
Diabetes Care. 2014 Jun;37(6):1516-24. (PMID: 24623024)
Crit Care. 2021 Mar 11;25(1):102. (PMID: 33706782)
Lancet Respir Med. 2023 Jul;11(7):602-612. (PMID: 36958363)
Diabetes Care. 2008 Aug;31(8):1473-8. (PMID: 18540046)
Clin Chem. 2009 Jan;55(1):18-20. (PMID: 19028817)
Semin Thorac Cardiovasc Surg. 2006 Winter;18(4):302-8. (PMID: 17395026)
Crit Care. 2020 Aug 31;24(1):536. (PMID: 32867803)
Neurocrit Care. 2008;9(2):159-66. (PMID: 18373223)
J Clin Invest. 2007 Apr;117(4):910-8. (PMID: 17404617)
Crit Care Med. 2018 Aug;46(8):1224-1229. (PMID: 29677007)
Endocr Pract. 2017 Mar;23(3):318-330. (PMID: 27967228)
PLoS One. 2016 Nov 8;11(11):e0165923. (PMID: 27824898)
J Crit Care. 2024 Feb;79:154429. (PMID: 37713997)
Intensive Care Med. 2017 Aug;43(8):1075-1084. (PMID: 28466149)
Chest. 2010 Mar;137(3):544-51. (PMID: 20018803)
Crit Care Med. 2009 Apr;37(4):1355-64. (PMID: 19242345)
Crit Care. 2025 Jul 11;29(1):297. (PMID: 40646628)
N Engl J Med. 2008 Jan 10;358(2):125-39. (PMID: 18184958)
Crit Care. 2014 Apr 30;18(2):R86. (PMID: 24886864)
JAMA. 2024 Aug 6;332(5):401-411. (PMID: 38873723)
Anesthesiology. 2009 Mar;110(3):611-9. (PMID: 19237874)
Chest. 2019 Nov;156(5):878-886. (PMID: 31201784)
Am J Respir Crit Care Med. 2022 Oct 1;206(7):874-882. (PMID: 35608484)
Crit Care. 2013 Mar 01;17(2):R37. (PMID: 23452622)
N Engl J Med. 2023 Sep 28;389(13):1180-1190. (PMID: 37754283)
Intensive Care Med. 2021 Nov;47(11):1319-1321. (PMID: 34533593)
Am J Respir Crit Care Med. 2024 Mar 1;209(5):497-506. (PMID: 37991900)
Intensive Care Med. 2015 Jun;41(6):1037-47. (PMID: 26088909)
J Diabetes Sci Technol. 2024 Mar;18(2):335-344. (PMID: 36112804)
Crit Care. 2013 Mar 19;17(2):R52. (PMID: 23510051)
Intensive Care Med. 2024 Jul;50(7):1035-1048. (PMID: 38771368)
N Engl J Med. 2001 Nov 8;345(19):1359-67. (PMID: 11794168)
JAMA. 2010 Jan 27;303(4):341-8. (PMID: 20103758)
Crit Care. 2008;12(6):R154. (PMID: 19055829)
Intensive Care Med. 2009 Oct;35(10):1738-48. (PMID: 19636533)
PLoS Med. 2014 Aug 19;11(8):e1001708. (PMID: 25136809)
N Engl J Med. 2012 Sep 27;367(13):1208-19. (PMID: 22957521)
Am J Respir Crit Care Med. 2010 Aug 1;182(3):351-9. (PMID: 20395554)
N Engl J Med. 2006 Feb 2;354(5):449-61. (PMID: 16452557)
Crit Care Med. 2009 Dec;37(12):3001-9. (PMID: 19661802)
Am J Respir Crit Care Med. 2023 Apr 1;207(7):945-949. (PMID: 36656551)
J Clin Endocrinol Metab. 2009 Sep;94(9):3163-70. (PMID: 19531590)
Crit Care Med. 2024 Apr 1;52(4):e161-e181. (PMID: 38240484)
J Crit Care. 2023 Oct;77:154327. (PMID: 37178493)
Crit Care Med. 2020 Mar;48(3):e233-e240. (PMID: 31876532)
Diabetes Care. 2013 Feb;36(2):188-94. (PMID: 22961576)
N Engl J Med. 2014 Jan 9;370(2):107-18. (PMID: 24401049)
J Clin Endocrinol Metab. 2011 Apr;96(4):E633-45. (PMID: 21270330)
N Engl J Med. 2017 Feb 23;376(8):729-741. (PMID: 28118549)
Intensive Care Med. 2024 Dec;50(12):2005-2018. (PMID: 39417874)
Crit Care. 2023 Jan 27;27(1):43. (PMID: 36707883)
Intensive Care Med. 2014 Feb;40(2):171-181. (PMID: 24420499)
Diabetes Care. 2026 Jan 1;49(Supplement_1):S339-S355. (PMID: 41358892)
Diabetes. 2006 Apr;55(4):1096-105. (PMID: 16567534)
Crit Care. 2017 Jul 31;21(1):197. (PMID: 28756769)
Crit Care Med. 2025 Dec 1;53(12):e2562-e2572. (PMID: 41051366)
Crit Care Med. 2003 Feb;31(2):359-66. (PMID: 12576937)
N Engl J Med. 2019 Dec 26;381(26):2541-2551. (PMID: 31881139)
Ann Intensive Care. 2025 Jul 15;15(1):99. (PMID: 40665004)
N Engl J Med. 2009 Mar 26;360(13):1283-97. (PMID: 19318384)
N Engl J Med. 2012 Sep 20;367(12):1108-18. (PMID: 22992074)
J Neurosurg Anesthesiol. 2007 Jul;19(3):156-60. (PMID: 17592345)
Mayo Clin Proc. 2004 Aug;79(8):992-1000. (PMID: 15301325)
BMJ. 2020 May 13;369:m1361. (PMID: 32404325)
Intensive Care Med. 2021 Nov;47(11):1271-1283. (PMID: 34590159)
J Clin Endocrinol Metab. 2012 Jun;97(6):2113-23. (PMID: 22442271)
Am J Respir Crit Care Med. 2025 Aug;211(8):1463-1473. (PMID: 40493436)
Crit Care Med. 2020 Dec;48(12):1744-1751. (PMID: 33031146)
Lancet. 2009 Feb 14;373(9663):547-56. (PMID: 19176240)
Crit Care. 2020 May 24;24(1):249. (PMID: 32448392)
Crit Care Med. 2011 Jan;39(1):105-11. (PMID: 20975552)
Endocrinology. 2012 May;153(5):2267-76. (PMID: 22396453)
Kidney Int. 2009 Sep;76(5):512-20. (PMID: 19536085)
N Engl J Med. 2011 Aug 11;365(6):506-17. (PMID: 21714640)
J Crit Care. 2024 Jun;81:154537. (PMID: 38364665)
NEJM Evid. 2024 Aug;3(8):EVIDoa2400082. (PMID: 38864749)
Crit Care Med. 2026 Aug 1;54(8):2090-2101. (PMID: 42262517)
Intensive Care Med. 2024 Dec;50(12):2171-2174. (PMID: 39470800)
Sci Transl Med. 2024 Jul 10;16(755):eadn9285. (PMID: 38985853)
Clin Nutr. 2023 Sep;42(9):1671-1689. (PMID: 37517372)
N Engl J Med. 2016 Mar 24;374(12):1111-22. (PMID: 26975590)
Crit Care. 2017 Aug 14;21(1):212. (PMID: 28806982)
Diabetes. 2006 Nov;55(11):3151-9. (PMID: 17065355)
Nat Commun. 2023 Dec 15;14(1):8345. (PMID: 38102152)
Contributed Indexing: Keywords: Blood glucose; Critical illness; Hyperglycaemia; Hypoglycaemia; Insulin; Intensive care; Parenteral nutrition
Substance Nomenclature: 0 (Blood Glucose)
0 (Hypoglycemic Agents)
0 (Insulin)
Entry Date(s): Date Created: 20260916 Date Completed: 20260916 Latest Revision: 20260917
Update Code: 20260917
PubMed Central ID: PMC13576187
DOI: 10.1186/s13054-026-06288-z
PMID: 42745269
Database: MEDLINE
Description
ISSN:1466-609X
DOI:10.1186/s13054-026-06288-z