Glycemic Control for Critically Ill Children and Adults

Clinicians should initiate glycemic management protocols and procedures to treat persistent hyperglycemia, ≥ 10 mmol/L (180 mg/dL) in critically ill adults. (U, CC)

Clinicians should use glycemic management protocols and procedures that demonstrate a low risk of hypoglycemia among critically ill adults and should treat hypoglycemia without delay. (U, CC)

Based on available randomized controlled trial data, in critically ill adults, we suggest against titrating an insulin infusion to a lower BG target INT: 4.4–7.7 mmol/L (80–139 mg/dL) as compared with a higher BG target range, CONV: 7.8–11.1 mmol/L (140–200 mg/dL) to reduce the risk of hypoglycemia. (C, M )

Observational data suggest a potential benefit of personalized glucose targets that more closely match chronic prehospital glycemic control. We recommend high-quality interventional trials of individualized glycemic targets in critically ill adults, stratified by prior glycemic control (such as indicated by glycosylated hemoglobin A1c). (C, U)

We suggest using continuous IV insulin infusion rather than intermittent subcutaneous insulin in the acute management of hyperglycemia in critically ill adults. (C, VL )

We suggest frequent (≤ 1 hr, continuous or near-continuous) glucose monitoring compared with monitoring at intervals greater than hourly in the management of hyperglycemia in critically ill adults on IV insulin during periods of glycemic instability. (C, L )

We suggest use of a protocol that includes explicit decision support tools (tools) over a protocol with no such tools in critically ill adults receiving IV insulin infusions for the management of hyperglycemia. (C, M )