Abstract
There is considerable physiological and clinical evidence of harm and increased risk of death associated with dysglycemiain critical care. However, glycemic control (GC) currently leads to increased hypoglycemia, independently associated with agreater risk of death. Indeed, recent evidence suggests GC is difficult to safely and effectively achieve for all patients. In thisreview, leading experts in the field discuss this evidence and relevant data in diabetology, including the artificial pancreas,and suggest how safe, effective GC can be achieved in critically ill patients in ways seeking to mimic normal isletcell function. The review is structured around the specific clinical hurdles of: understanding the patient’s metabolicstate; designing GC to fit clinical practice, safety, efficacy, and workload; and the need for standardized metrics. Theseaspects are addressed by reviewing relevant recent advances in science and technology. Finally, we provide a set ofconcise recommendations to advance the safety, quality, consistency, and clinical uptake of GC in critical care. Thisreview thus presents a roadmap toward better, more personalized metabolic care and improved patient outcomes.