Differentiating between people with and without diabetes can be useful for controlling and monitoring blood glucose levels in patients in the intensive care unit (ICU). This is the argument made by authors Andreas Birkenfeld, speaker of the German Center for Diabetes Research (DZD) and Medical Director of the Clinic for Diabetology, Endocrinology and Nephrology at Tübingen University Hospital, and Christian von Loeffelholz, Jena University Hospital, in an opinion piece in the specialist magazine ‘Lancet D&E’. They highlight the importance of individualized therapy regimens for ICU patients with diabetes but also point out the need for further detailed data and studies.

Stress hyperglycemia, hypoglycemia, and diabetes are common in critically ill patients. To avoid complications, it is recommended to initiate insulin therapy for patients with persistent blood sugar values of over 10.0 mmol/l, targeting a range of 7.8-10.0 mmol/l. Recent randomized controlled clinical trials now challenge these recommendations and show that there are differences between ICU patients with and without diabetes in terms of risk assessment and blood glucose management. Stricter target values could be appropriate for specific patient groups. Current recommendations support glycemic targets of 6.1–7.8 mmol/l. In this regard, it is important to consider individual differences and carefully monitor blood sugar values in order to find a balance between strict target values and the prevention of hypoglycemic episodes. Computerized algorithms for managing blood sugar and innovative technologies, such as continuous glucose monitoring, could help with this.

The authors highlight the importance of individualized therapy regimens for ICU patients with diabetes, as individual risk profiles and blood glucose tolerances can vary. Observational studies point to increased mortality with liberal glucose control among patients with admission HbA1c of less than 6.5%. This suggests the existence of subgroups of people with diabetes that could benefit from stricter blood glucose targets. In ICU patients with diabetes, pre-admission HbA1c of at least 8% can be considered as an indication of increased risk of relative hypoglycemia.

The authors emphasize the need for further research to determine which subgroups of patients could benefit from stricter blood glucose target ranges. It is also important to further investigate sex differences in the blood glucose target ranges of patients in the ICU as well as the possible effects of the female menstrual cycle on blood sugar values.

In an era of technological, bioinformatic, and therapeutic advances and the increasing importance of precision strategies, it is important to test new approaches to offer improved treatment options for all ICU patients. The authors appeal to all stakeholders to work together to achieve this important goal.

Original publication
Christian von Loeffelholz , Andreas L Birkenfeld 2024: Tight versus liberal blood-glucose control in the intensive care unit: special considerations for patients with diabetes. The Lancet Diabetes and Endocrinology. DOI: 10.1016/S2213-8587(24)00058-5

Scientific contact:
Prof. Dr. med. Andreas Birkenfeld
Telefon: 07071 29-82735
E-Mail: andreas.birkenfeld(at)med.uni-tuebingen.de
 

Helmholtz Munich is a leading biomedical research center. Its mission is to develop breakthrough solutions for better health in a rapidly changing world. Interdisciplinary research teams focus on environmentally triggered diseases, especially the therapy and prevention of diabetes, obesity, allergies and chronic lung diseases. With the power of artificial intelligence and bioengineering, the researchers accelerate the translation to patients. Helmholtz Munich has more than 2,500 employees and is headquartered in Munich/Neuherberg. It is a member of the Helmholtz Association, with more than 43,000 employees and 18 research centers the largest scientific organization in Germany. More about Helmholtz Munich (Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt GmbH): www.helmholtz-munich.de/en     

Founded in 1805, Tübingen University Hospital is one of the leading centers of German university medicine. As one of the 33 university hospitals in Germany, it contributes to the successful combination of high-performance medicine, research and teaching. Well over 400,000 inpatients and outpatients from all over the world benefit annually from this combination of science and practice. The clinics, institutes and centers unite all specialists under one roof. The experts work together across disciplines and offer each patient the best possible treatment based on the latest research findings. Tübingen University Hospital conducts research for better diagnoses, therapies and healing chances; many new treatment methods are clinically tested and applied here. In addition to diabetology, neuroscience, oncology, immunology, infection research and vascular medicine are research priorities in Tübingen. The Department of Diabetology /Endocrinology has been the center of interdisciplinary research over the past 25 years, especially with the participation of surgery, radiology and laboratory medicine. This important discovery of the prediabetes subtypes was only possible due to the interdisciplinary collaboration between the hospital’s various departments. Tübingen University Hospital is a reliable partner in four of the six German Centers for Health Research initiated by the German Federal Government. www.medizin.uni-tuebingen.de 

The German Center for Diabetes Research (DZD) is a national association that brings together experts in the field of diabetes research and combines basic research, translational research, epidemiology and clinical applications. The aim is to develop novel strategies for personalized prevention and treatment of diabetes. Members are Helmholtz Munich – German Research Center for Environmental Health, the German Diabetes Center in Düsseldorf, the German Institute of Human Nutrition in Potsdam-Rehbrücke, the Paul Langerhans Institute Dresden of Helmholtz Munich at the University Medical Center Carl Gustav Carus of the TU Dresden and the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the Eberhard-Karls-University of Tuebingen together with associated partners at the Universities in Heidelberg, Cologne, Leipzig, Lübeck and Munich. www.dzd-ev.de/en