Management of dysglycemia in critically ill adults: current evidence, clinical practice and future directions
- 1Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- 2Medicine, Emory University, Atlanta, Georgia, USA
Abstract
Hyperglycemia is among the most common metabolic disturbances in critically ill patients, affecting up to 50% of adults admitted to intensive care units (ICUs), regardless of pre-existing diabetes. Both diabetes and stress-induced hyperglycemia are associated with increased risk of organ dysfunction, healthcare-associated infections, prolonged mechanical ventilation, longer ICU and hospital length of stay, and mortality. Clinical guidelines recommend initiating intravenous insulin therapy when blood glucose remains ≥180 mg/dL (10.0 mmol/L) and targeting 140–180 mg/dL (7.8–10.0 mmol/L) for most critically ill adults. Recent advances in continuous glucose monitoring, computerized insulin dosing algorithms, automated insulin delivery systems and artificial intelligence-enabled clinical decision support are transforming glucose management in the ICU and have the potential to improve safety and efficiency. This review summarizes current understanding of the pathophysiology of stress hyperglycemia, the clinical consequences of dysglycemia, contemporary glucose targets, insulin therapy and glucose monitoring strategies. We also highlight emerging technologies, special patient populations and future directions expected to shape precision glycemic management for critically ill adults.
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BibTeX
@article{idrees2026management,
title = {{Management of dysglycemia in critically ill adults: current evidence, clinical practice and future directions}},
author = {Thaer Idrees and Srija Nalabolu and Omolade Oladejo and Ghada Elshimy and Claudia Orobio and Guillermo E Umpierrez},
journal = {BMJ Open Diabetes Research \& Care},
year = {2026},
month = oct,
doi = {10.1136/bmjdrc-2026-006533},
url = {https://doi.org/10.1136/bmjdrc-2026-006533},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Management of dysglycemia in critically ill adults: current evidence, clinical practice and future directions
AU - Thaer Idrees
AU - Srija Nalabolu
AU - Omolade Oladejo
AU - Ghada Elshimy
AU - Claudia Orobio
AU - Guillermo E Umpierrez
PY - 2026
DA - 2026/10/01
JO - BMJ Open Diabetes Research & Care
DO - 10.1136/bmjdrc-2026-006533
UR - https://doi.org/10.1136/bmjdrc-2026-006533
AB - Hyperglycemia is among the most common metabolic disturbances in critically ill patients, affecting up to 50% of adults admitted to intensive care units (ICUs), regardless of pre-existing diabetes. Both diabetes and stress-induced hyperglycemia are associated with increased risk of organ dysfunction, healthcare-associated infections, prolonged mechanical ventilation, longer ICU and hospital length of stay, and mortality. Clinical guidelines recommend initiating intravenous insulin therapy when blood glucose remains ≥180 mg/dL (10.0 mmol/L) and targeting 140–180 mg/dL (7.8–10.0 mmol/L) for most critically ill adults. Recent advances in continuous glucose monitoring, computerized insulin dosing algorithms, automated insulin delivery systems and artificial intelligence-enabled clinical decision support are transforming glucose management in the ICU and have the potential to improve safety and efficiency. This review summarizes current understanding of the pathophysiology of stress hyperglycemia, the clinical consequences of dysglycemia, contemporary glucose targets, insulin therapy and glucose monitoring strategies. We also highlight emerging technologies, special patient populations and future directions expected to shape precision glycemic management for critically ill adults.
SN - 2052-4897
ER -