Glycemic control clearly improves outcome in critically ill patients. Remaining questions are how tight the control must be to obtain the most benefit without increasing the risk for severe hypoglycemia, and whether an acuity level exists in which this benefit is not clearly visualized. In other words, is this benefit only seen in severely ill patients? The authors believe that clinical trials with ICU lengths of stay of 3 days or less make showing a clinical benefit difficult. Rather, they believe that clinical benefit is seen in higher acuity patients whose ICU length of stay is directly related to the reversal of the inflammatory systemic response rather than the disease or injury alone. Finally, the issue remains of how to obtain a TGC in the 80 to 110 mg/dL range without achieving a less-than-acceptable incidence of hypoglycemia. The answer may well lie with the introduction of continuous glucose monitors that will allow measurements to be obtained every 15 to 30 minutes without introducing an increased workload to the nursing staff. Many of these devices, such as the Optiscanner, which measures plasma glucose continuously, are on the horizon and should be approved by the FDA in 2008.
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