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

Chase, J Geoffrey 
Desaive, Thomas 
Bohe, Julien 
Cnop, Miriam 
De Block, Christophe 

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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.

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Artificial pancreas, Endocrine function, Glycemic control, In silico, Model based, Modeling, Review, Validation, Virtual patient, Critical Illness, Glycemic Load, Humans, Hyperglycemia, Hypoglycemia, Islets of Langerhans, Metabolism
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Crit Care
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Springer Science and Business Media LLC