Improved outcome with aggressive treatment of hyperglycemia: Hype or hope?

Over the years, the standard for ideal glycemic control in diabetic patients has moved closer and closer to achieving normal blood glucose levels. This evolution has been driven primarily by improvements in our technical ability to achieve more precise control. Through this process it has become clear that in diabetic patients, the better the glycemic control, the better the outcome. Hyperglycemia, however, is not confined to diabetics. It occurs in acutely ill patients with many disorders. In addition, hyperglycemic (diabetic and nondiabetic) patients have a worse outcome, be it in the setting of an acute myocardial infarction, intracerebral hemorrhage, acute ischemic stroke, head injury, or admission to a medical-surgical intensive care unit (ICU). What has remained unsettled is which is the horse and which is the cart: is hyperglycemia and epiphenomenon, simply a market of metabolic perturbations caused by the primary insult, or is it a bad actor directly contributing to morbidity and mortality? Van den Berghe et al. have recently provided compelling data that directly address this question. In 2001, …