Tight Glycemic Control - The leading role of insulin sensitivity in determining efficacy and thus outcome

Tight glycaemic control (TGC) has emerged as a major focus in critical care. However, repeating the initial successful reductions in reducing mortality and other outcomes via TGC has proven very difficult. Hence, there has been growing debate over the necessity of TGC, its goals, safety from hypoglycemia, and target cohorts. This article reviews existing knowledge and results to provide a new interpretation and explanation for the variable results in applying TGC. It then uses a validated metabolic system model to show how the root cause is the intra- and inter- patient variability, which makes TGC difficult over diverse cohorts and thus yields such variable results over many protocols.