Hemoglobin A1c and

P e r m i s s i v e Hy p e r g l y c e m i a i n
P a t ients in th e I n t en s i v e C a re
Unit with Diabetes
a b,c,
Anca Balintescu, MD , Johan Mårtensson, MD, PhD *

KEYWORDS
 Diabetes  HbA1c  Critical care  Hyperglycemia  Hypoglycemia
 Glucose variability

KEY POINTS
 Quantification of glycated hemoglobin A1c, a measure of the average blood glucose level
over the prior 2 to 3 months, can identify intensive care unit patients with deranged chronic
glycemic control.
 Hyperglycemia and glucose fluctuations are better tolerated by patients with elevated gly-
cated hemoglobin A1c than by patients with normal or near normal glycated hemoglobin
A1c.
 Iatrogenic hypoglycemia, a potentially fatal complication, is common and is associated
with greater risks among critically ill patients with elevated glycated hemoglobin A1c.
 Permissive hyperglycemia (blood glucose target 10–14 mmol/L) effectively decreases the
incidence of hypoglycemia among critically ill patients with elevated glycated hemoglobin
A1c.

INTRODUCTION

There are nearly half a billion adults with diabetes mellitus worldwide.1 But about one-
half of them are still unaware of their disease. For that reason, the prevalence of
diabetes among critically ill patients admitted to the intensive care unit (ICU) has

Disclosure Statement: The authors declare that they have no conflicts of interest.
a
Department of Clinical Science and Education Södersjukhuset, Section of Anaesthesia and
Intensive Care, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, Stockholm 118 83,
Sweden; b Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive
Care, Karolinska Institutet, Solnavägen 9, Stockholm, 171 65 Solna, Sweden; c Function Peri-
operative Medicine and Intensive Care, Karolinska University Hospital, Stockholm 171
76, Sweden
* Corresponding author. Function Perioperative Medicine and Intensive care, Karolinska Uni-
versity Hospital, Stockholm 171 76, Sweden.
E-mail address: johan.martensson@sll.se

Crit Care Clin 35 (2019) 289–300

https://doi.org/10.1016/j.ccc.2018.11.010 criticalcare.theclinics.com
0749-0704/19/ª 2018 Elsevier Inc. All rights reserved.