Stress hyperglycaemia, hypoglycaemia, and diabetes are common in critically ill patients and related to clinical endpoints. To avoid complications related to hypoglycaemia and hyperglycaemia, it is recommended to start insulin therapy for the majority of critically ill patients with persistent blood glucose concentrations higher than 10·0 mmol/L (>180 mg/dL), targeting a range of 7·8–10·0 mmol/L (140–180 mg/dL). However, management and evidence-based targets for blood glucose control are under debate, particularly for patients with diabetes. Recent randomised controlled clinical trials now challenge current recommendations. In this Personal View, we aim to highlight these developments and the important differences between critically ill patients with and without diabetes, taking into account the considerable heterogeneity in this patient group. We critically discuss evidence from prospective randomised controlled trials and observational studies on the safety and efficacy of glycaemic control, specifically in the context of patients with diabetes in intensive care units.

中文翻译：

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重症监护病房中严格与宽松的血糖控制：糖尿病患者的特殊考虑

应激性高血糖、低血糖和糖尿病在危重患者中很常见，并且与临床终点相关。为避免低血糖和高血糖相关并发症，建议对大多数血糖浓度持续高于10·0 mmol/L（>180 mg/dL）的重症患者开始胰岛素治疗，目标范围为7· 8–10·0 毫摩尔/升（140–180 毫克/分升）。然而，血糖控制的管理和循证目标仍存在争议，特别是对于糖尿病患者而言。最近的随机对照临床试验现在对当前的建议提出了挑战。在本个人观点中，我们旨在强调这些进展以及患有和不患有糖尿病的危重患者之间的重要差异，同时考虑到该患者群体中相当大的异质性。我们批判性地讨论关于血糖控制的安全性和有效性的前瞻性随机对照试验和观察性研究的证据，特别是在重症监护病房的糖尿病患者的背景下。