Improving glycemic control in critically ill patients: personalized care to mimic the endocrine pancreas.
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Authors
Chase, J Geoffrey
Desaive, Thomas
Bohe, Julien
Cnop, Miriam
De Block, Christophe
Gunst, Jan
Kalfon, Pierre
Krinsley, James
Renard, Eric
Preiser, Jean-Charles
Publication Date
2018-08-02Journal Title
Crit Care
ISSN
1364-8535
Publisher
Springer Science and Business Media LLC
Volume
22
Issue
1
Pages
182
Language
eng
Type
Article
Physical Medium
Electronic
Metadata
Show full item recordCitation
Chase, J. G., Desaive, T., Bohe, J., Cnop, M., De Block, C., Gunst, J., Hovorka, R., et al. (2018). Improving glycemic control in critically ill patients: personalized care to mimic the endocrine pancreas.. Crit Care, 22 (1), 182. https://doi.org/10.1186/s13054-018-2110-1
Abstract
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.
Keywords
Islets of Langerhans, Humans, Hyperglycemia, Hypoglycemia, Critical Illness, Metabolism, Glycemic Load
Identifiers
External DOI: https://doi.org/10.1186/s13054-018-2110-1
This record's URL: https://www.repository.cam.ac.uk/handle/1810/280085
Rights
Attribution 4.0 International (CC BY 4.0)
Licence URL: https://creativecommons.org/licenses/by/4.0/
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