In the past decade, convincing evidence has emerged that perioperative glycemic control in certain settings, especially cardiac surgery and the surgical ICU, can decrease morbidity and mortality. It remains unclear, however, if hypoglycemia is a cause of death or marker of patient acuity. It is clear, however, that the particular intensive glycemic control protocol matters because the rate of hypoglycemia varies across protocols and institutions. The best current evidence for tight control rests in the population of surgical patients needing more than 5 days of critical care. Many questions still remain, such as the optimum blood sugar or the best protocol to implement glucose control, minimizing hypoglycemia. Further information will become available from the Normogylcemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation trial, currently enrolling patients in a prospective randomized trial to answer some of these outstanding questions. Maintaining euglycemia postoperatively is a simple and actionable step that could decrease the risk of postoperative infections and postoperative mortality.
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