Moving closer to untangling a sweet web: hyperglycemia, diabetic status, and mortality in the critically ill.

摘要

Intensive glycemic monitoring and treatment of even modest degrees of hyperglycemia with insulin has become a standard of care in the intensive care unit (ICU) in the nearly 8 years since publication of the first Leuven trial (1). In this issue of Critical Care Medicine, the investigation by Graham et al (2) explores the question of whether diabetes is an independent risk factor for mortality in critically ill patients and concludes, emphatically, that it is not. In fact, the opposite may be the case. It may be the suggestion of a protective effect of diabetes.The major strength of this study is its immense size. Two separate databases were used. The University HealthSource Consortium included 1,509,890 patients treated in 130 academic medical centers between 2003 and 2006, and the Mayo Clinic critical care database contributed an additional 36,414 patient from four ICU at that institution admitted between 1999 and 2007. Two different risk adjustment models were used, but a similar conclusion was reached: severity-adjusted mortality was lower among diabetic subjects in both cohorts.