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Báo cáo y học: "Moving beyond tight glucose control to safe effective glucose control"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Moving beyond tight glucose control to safe effective glucose control. | Available online http ccforum.eom content 12 3 149 Commentary Moving beyond tight glucose control to safe effective glucose control James S Krinsley1 and Jean-Charles Preiser2 1 Division of Critical Care Stamford Hospital 190 West Broad Street Stamford CT 06902 USA 2Department of General Intensive Care University Hospital Centre of Liege Domaine Universitaire de Liège 4000 Liege Belgium Corresponding author Jean-Charles Preiser Jean-Charles.Preiser@chu.ulg.ac.be Published 16 May 2008 This article is online at http ccforum.com content 12 3 149 2008 BioMed Central Ltd Critical Care 2008 12 149 doi 10.1186 cc6889 Abstract The impressive benefits related to the use of tight glucose control by intensive insulin therapy have not been reproduced until now in multicenter large-scale prospective randomized trials. Although the reasons for these failures are not entirely clear we suggest the use of a stepwise approach - Safe Effective Glucose Control - that will essentially target an intermediate blood glucose level. As compared with genuine tight glucose control Safe Effective Glucose Control - already used in many intensive care units worldwide - is intended to decrease the rate of hypoglycemia and the workload while reducing the adverse effects of severe hyperglycemia. In 2001 following in the path of the glycemic pioneers 1-3 the Leuven 1 investigators published their landmark study of intensive insulin therapy in a population of surgical intensive care unit ICU patients targeting 80 to 110mg dl in the interventional arm 4 . This prospective controlled randomized trial spurred clinicians in ICUs around the world to adopt tight glycemic control TGC 5 . Confirmation of the mortality benefit of TGC in a mixed medical-surgical ICU setting was seen in the nonrandomized Stamford study published nearly 3 years later 6 7 . An additional 2 years elapsed until the publication of the Leuven II study performed in a medical ICU which demonstrated reduced mortality in the predefined .