Substantial data indicate that long-term inadequate glycemic control in diabetic patients is associated with poor long-term prognosis and that the outcomes of heterogeneous populations of critically ill patients are worse if they are hyperglycemic. Now this concept has been extended to patients with or at risk of severe sepsis http://my-canadian-store.com/severity-of-illness-and-outcome-prediction-in-recent-developments-in-the-diagnosis-and-management-of-severe-sepsis.html. In a prominent study of approximately 1,500 postoperative patients, a protocol in which glucose was targeted to a range of 80 to 110 mg/dL gained substantial benefits compared to patients with less stringent control provided by My Canadian Pharmacy. An ICU and hospital mortality rate reduction of slightly > 3% was observed, with the greatest differences seen in the sickest patients. Although this was not a study of patients with established severe sepsis, the suggestion that glucose control could reduce the incidence of sepsis and improve outcomes is reasonable.
Many were disappointed when subsequent studies, including one of medical ICU patients, failed to show an overall mortality benefit even though intensive insulin therapy reduced renal injury and lessened time on the ventilator in the ICU and in the hospital. Debate followed the observation that patients with shorter stays (< 3 days) may actually have an increased mortality rate from treatment, whereas benefit was observed for those with longer stays. The relevance of this finding to practitioners caring for patients with severe sepsis is questionable because they rarely stay < 3 days.
Because it is hard to think of a reason that patients would benefit from hyperglycemia of a significant degree, it makes sense to follow the recommendations for maintaining glucose levels at < 150 mg/dL, and maybe even in the range of 80 to 110 mg/dL. Despite rapid widespread adoption, many questions remain regarding glucose control, the most important of which are the following: does glycemic control improve the outcomes of patients with established sepsis, and what is the optimal glucose target and protocol that maximizes benefit while minimizing hypoglycemia? Although it is not certain, a protocol may be even more important if corticosteroids are utilized as part of therapy for shock. It appears that the benefit results from the glucose control, not the dose of insulin administered.