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lüll Reducing glycemic variability in intensive care unit patients: a new therapeutic target?Egi M; Bellomo RJ Diabetes Sci Technol 2009[Nov]; 3 (6): 1302-8Acute hyperglycemia is common in critically ill patients. Strict control of blood glucose (BG) concentration has been considered important because hyperglycemia is associated independently with increased intensive care unit mortality. After intensive insulin therapy was reported to reduce mortality in selected surgical critically ill patients, lowering of BG levels was recommended as a means of improving patient outcomes. However, a large multicenter multination study has found that intensive insulin therapy increased mortality significantly. A difference in variability of BG control may be one possible explanation why the effect of intensive insulin therapy varied from beneficial to harmful. Several studies have confirmed significant associations between variability of BG levels and patient outcomes. Decreasing the variability of the BG concentration may be an important dimension of glucose management. If reducing swings in the BG concentration is a major biologic mechanism behind the putative benefits of glucose control, it may not be necessary to pursue lower glucose levels with their attendant risk of hypoglycemia.|*Critical Illness/mortality[MESH]|Acute Disease[MESH]|Blood Glucose Self-Monitoring[MESH]|Blood Glucose/drug effects/*metabolism[MESH]|Critical Care[MESH]|Humans[MESH]|Hyperglycemia/blood/*diagnosis/drug therapy/mortality[MESH]|Hypoglycemia/blood/chemically induced[MESH]|Hypoglycemic Agents/administration & dosage/adverse effects[MESH]|Insulin/administration & dosage/adverse effects[MESH]|Predictive Value of Tests[MESH]|Risk Assessment[MESH]|Risk Factors[MESH]|Time Factors[MESH]|Treatment Outcome[MESH] |