Nursing Perspectives on Glycemic Control for Critically Ill Adults in the Intensive Care Unit: A Narrative Review

Abstract

Abstract

BACKGROUND: Glycemic control involves methods for measuring, evaluating, and correcting blood glucose levels to maintain glucose homeostasis. It is essential to reduce hyperglycemia-related complications while minimizing the risk of hypoglycemia, and registered nurses (RNs) play a key role in blood glucose monitoring and insulin therapy management in the intensive care unit (ICU).​. OBJECTIVES: To provide a thorough synthesis of nursing perspectives on glycemic control practices for critically ill adult patients admitted to the ICU. METHODS: We conducted a narrative review of the literature using PubMed, Scopus, CINAHL, and Google Scholar, complemented by manual searches of relevant scientific society websites, textbooks, and reference lists. RESULTS: Available evidence suggests initiating glycemic control for persistent hyperglycemia at ≥180 mg/dL (10 mmol/L) and titrating therapy to an individualized target based on patient evaluation. Arterial blood samples should be prioritized for glucose measurement when available, followed by venous and capillary sampling, individualizing the monitoring frequency. Continuous intravenous insulin infusion is generally recommended, guided by a standardized protocol specifying treatment thresholds, target ranges, insulin infusion adjustments, and monitoring frequency. CONCLUSIONS: This narrative review summarizes nursing perspectives on glycemic control in critically ill adult ICU patients, including glucose measurement, individualized monitoring frequency, and protocol-based intravenous insulin infusion management. Evidence gaps remain regarding the optimal application of these approaches, and nursing research should focus on both patient-centered and organizational outcomes.