Hence, there is EPZ-5676 Histone Methyltransferase inhibitor little inter clinician variability in glucose management in the current study population. Glycemic variability may cause Inhibitors,Modulators,Libraries harmful effects. Among patients with type II diabetes, increased glycemic variability is associated with increased protein kinase C B, a marker of oxidative stress. Increased glycemic variability also increases oxidative stress at the cellular level. Nevertheless, no study, including this one, has demonstrated a causal relationship between glycemic variability and ICU death. Glycemic variability may simply be an epiphenomenon of a critically ill patients inability to maintain homeostasis. While this study cannot determine the validity of this possibility, some of its results offer insight into the relationship between glycemic variability and mortality.

Because the eProtocol insulin was identical for diabetics and non diabetics, the differences in glycemic variability between these two Inhibitors,Modulators,Libraries groups are likely caused by patient specific factors. A non diabetic patient who requires IV insulin has, by definition, already lost ability to maintain glucose homeostasis. At least some component of this glucose dysregulation is reasonably inferred to be the result of critical illness, not its cause. We found the association Inhibitors,Modulators,Libraries between blood glucose coefficient of variation and mortality was significantly greater in non diabetics than in diabetics. Although we adjusted for disease severity, the acute physiology score we used is far from a comprehensive assessment of disease severity.

We are unable to account for every possible indicator of disease severity, and it is possible that unmeasured indicators of disease severity confound the association between glycemic variability and mortality. If the increased mortality was caused solely by increased glycemic variability, we would expect similar associations Inhibitors,Modulators,Libraries in diabetics and non diabetics, and expect that diabetics, would have greater mortality. Our results support neither of these expectations. While we think it is likely Inhibitors,Modulators,Libraries that some component of glycemic variability is caused by disease severity, we recognize that increased glycemic variability, itself, may have an adverse effect on patient outcome. Our data do not allow for inferences of mortality benefit from reduction of glycemic variability. Our study used a threshold of 60 mg dL for hypoglycemia. This threshold is lower than the 70 mg dL threshold commonly reported in the literature. selleck chem Ivacaftor Our rationale for this threshold is that the protocol becomes discontinuous at 60 mg dL, which may have significant effects on glycemic variation.