Should Glucocorticoid-Induced Hyperglycemia Be Treated in Patients With Septic Shock?

KEYWORDS:
• ADRENAL CORTEX HORMONES
• BLOOD GLUCOSE
• CRITICAL CARE
• DRUG REACTION, ADVERSE
• DRUG THERAPY
• GLUCOCORTICOIDS
• HOSPITAL MORTALITY
• HYPERGLYCEMIA
• INSULIN
• SHOCK, SEPTIC

Critical illness, in particular severe sepsis, induces insulin resistance and hyperglycemia. Corticosteroids are often used for reversal of fluid- and vasopressor-resistant septic shock. Such an adjuvant treatment aggravates illness-induced hyperglycemia, even in a low-dose steroid regimen.¹ For glucocorticoid-induced hyperglycemia in noncritically ill patients, there is general agreement on treatment, because prolonged hyperglycemia causes cardiovascular and infectious complications.² Whether patients in septic shock in the intensive care unit (ICU) with glucocorticoid-induced aggravation of “diabetes of injury” should be treated is controversial. This debate is embedded in the overall controversy about whether to treat critically ill patients with hyperglycemia with insulin, and if so, to what blood glucose level.³

In this issue of JAMA, the Corticosteroids and Intensive Insulin Therapy for Septic Shock (COIITSS) study investigators consortium⁴ report the results of a multicenter randomized controlled trial that addresses this relevant question. The primary hypothesis the authors aimed …