Open research questions in Hyperglycemia and glycemic control in critically ill and hospitalized patients

What the literature leaves open

• The dynamic trajectories and cumulative stress hyperglycemia ratio burden have not been fully investigated. The link between stress hyperglycemia ratio and common prognostic indicators is not well understood. The prognostic significance of stress hyperglycemia ratio trajectories in ICU patients with heart failure is not fully explored.

  Association of stress hyperglycemia ratio trajectories and cumulative stress hyperglycemia burden with in-hospital mortality in ICU patients with heart failure: a retrospective cohort study · 2026 · DOI

• Prospective validation of GPR in ICU sepsis patients, - Investigation of the protective effects of moderate metabolic stress, - Examination of the relationship between GPR and cardiac instability

  Association between serum glucose potassium ratio and short- and long-term all-cause mortality in patients with sepsis admitted to the intensive care unit: a retrospective analysis based on the MIMIC-IV database · 2025 · DOI

• Prior studies have shown conflicting results regarding the glucose potassium ratio in sepsis patients. There is a lack of large-scale validation of the glucose potassium ratio in ICU sepsis patients. The inconsistencies in prior literature need to be addressed.

  Association between serum glucose potassium ratio and short- and long-term all-cause mortality in patients with sepsis admitted to the intensive care unit: a retrospective analysis based on the MIMIC-IV database · 2025 · DOI

• Investigating the effect of other factors on the relationship between GV and prognosis in HS patients. Examining the relationship between GV and prognosis in other types of stroke. Studying the impact of GV on long-term outcomes in HS patients. Investigating the mechanisms underlying the U-shaped association between GV and mortality

  U−shaped association between the glycemic variability and prognosis in hemorrhagic stroke patients: a retrospective cohort study from the MIMIC-IV database · 2025 · DOI

• Investigate the relationship between SHR and SA-AKI in other patient populations, - Examine the potential benefits of early SA-AKI detection, - Explore the use of SHR as a predictor for SA-AKI in clinical practice

  Association between stress hyperglycemia ratio and acute kidney injury development in patients with sepsis: a retrospective study · 2025 · DOI

• Further studies are needed to explore the role of stress hyperglycemia in predicting the prognosis of patients with AMI, - Research should investigate the mechanisms linking stress hyperglycemia to adverse outcomes, - Studies should examine the effects of stress hyperglycemia on microvascular obstruction, endothelium-dependent vasodilatory function, and platelet nitric oxide reactivity

  Stress hyperglycemia ratio and risk of incident myocardial infarction in the general population: a large-scale cohort study · 2025 · DOI

• Interstitial continuous glucose monitoring (CGM) could improve surveillance, but its performance during rapid glucose excursions remains uncertain.

  Accuracy of an Interstitial Continuous Glucose Management System in Critically Ill Patients: A Prospective Observational Study · 2026 · DOI

• However, the prognostic significance of the dynamic trajectories of the stress hyperglycemia ratio (SHR) remains poorly understood.

  Persistent stress hyperglycemia trajectories predict mortality in sepsis: a machine learning-enhanced cohort study · 2026 · DOI

• However, the relationship between GV and prognosis in ICU patients with hemorrhagic stroke (HS) remains unclear.

  U−shaped association between the glycemic variability and prognosis in hemorrhagic stroke patients: a retrospective cohort study from the MIMIC-IV database · 2025 · DOI

• However, its predictive value for sepsis-associated acute kidney injury (SA-AKI) remains unclear.

  Association between stress hyperglycemia ratio and acute kidney injury development in patients with sepsis: a retrospective study · 2025 · DOI

• The prognostic utility of GV in CI patients for predicting acute kidney injury (AKI) remains inadequately characterized.

  Association between glycemic variability and acute kidney injury incidence in patients with cerebral infarction: an analysis of the MIMIC-IV database · 2025 · DOI

• Its association with acute myocardial infarction (AMI) risk in the general population remains unclear.

  Stress hyperglycemia ratio and risk of incident myocardial infarction in the general population: a large-scale cohort study · 2025 · DOI

• Background The role of the triglyceride-glucose (TyG) index in critically ill patients with congestive heart failure (CHF) and atrial fibrillation (AF), requiring intensive care unit (ICU) admission, remains unclear.

  Association between triglyceride-glucose index and all-cause mortality in patients with congestive heart failure and atrial fibrillation · 2025 · DOI

• While hypoglycemia and hyperglycemia are known risk factors for adverse outcomes, the optimal glycemic range for patients undergoing ECC remains unclear.

  The relationship between blood glucose and clinical outcomes after extracorporeal circulation: a retrospective cohort study · 2025 · DOI

• However, the relationship between SHR and mortality in non-diabetic septic patients remains unclear.

  Stress hyperglycemia ratio as a mortality predictor in non-diabetic septic patients: a retrospective cohort analysis · 2025 · DOI

• Insulin titration for glycemic control in T2D is crucial but limited by the lack of personalized and real-time tools.

  Real-Time AI-Assisted Insulin Titration System for Glucose Control in Patients With Type 2 Diabetes · 2025 · DOI

• These findings underscore the importance of considering SHR as a potential prognostic factor in the critical care management of cardiac arrest patients, warranting further investigation and clinical attention.

  Impact of stress hyperglycemia ratio on mortality in patients with cardiac arrest: insight from American MIMIC-IV database · 2024 · DOI

• However, its role in determining outcomes in patients with atrial fibrillation (AF) within the intensive care unit (ICU) remains unclear.

  Association between stress hyperglycemia ratio and all-cause mortality in critically ill patients with atrial fibrillation: insights from a MIMIC-IV study · 2024 · DOI

• Introduction Congenital Hyperinsulinism (CHI) has not been previously studied in Ukraine.

  Congenital hyperinsulinism in the Ukraine: a 10-year national study · 2024 · DOI

• However, the relationship between the triglyceride-glucose (TyG) index, heart failure, diabetes, and the length of hospital stay (LHS) in patients with cerebrovascular disease in the ICU remains uncertain.

  Association between the triglyceride glucose index and length of hospital stay in patients with heart failure and type 2 diabetes in the intensive care unit: a retrospective cohort study · 2024 · DOI

• However, its role in critically ill patients with acute heart failure (acute HF) remains underexplored.

  The association between stress hyperglycemia ratio with mortality in critically ill patients with acute heart failure · 2024 · DOI

• However, the relationship between SHR and mortality in patients with sepsis-associated acute kidney injury (SA-AKI) remains unclear.

  The association between stress hyperglycemia ratio and clinical outcomes in patients with sepsis-associated acute kidney injury: a secondary analysis of the MIMIC-IV database · 2024 · DOI

• BACKGROUND: The relationship between the dynamic changes in insulin resistance (IR) and the prognosis of septic patients remains unclear.

  The triglyceride-glucose index dynamic trajectory reveals the association between the clinical subphenotype of insulin resistance and mortality in patients with sepsis · 2024 · DOI

• BACKGROUND: The management of preoperative blood glucose levels in reducing the incidence of postoperative delirium (POD) remains controversial.

  Association between preoperative persistent hyperglycemia and postoperative delirium in geriatric hip fracture patients · 2024 · DOI

• Importance: The circumstances under which neonatal hypoglycemia leads to brain damage remain unclear due to a lack of long-term data on the neurodevelopment of affected children.

  Transitional Neonatal Hypoglycemia and Adverse Neurodevelopment in Midchildhood · 2024 · DOI

Most-cited papers in Hyperglycemia and glycemic control in critically ill and hospitalized patients

• Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) · The Lancet · 1998 · 15,582 citations
• Intensive Insulin Therapy in Critically Ill Patients · New England Journal of Medicine · 2001 · 7,800 citations
• Effects of Intensive Glucose Lowering in Type 2 Diabetes · New England Journal of Medicine · 2008 · 6,587 citations
• Intensive versus Conventional Glucose Control in Critically Ill Patients · New England Journal of Medicine · 2009 · 4,074 citations
• Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 Diabetes · New England Journal of Medicine · 2005 · 4,031 citations
• Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes · New England Journal of Medicine · 2008 · 3,898 citations
• Intensive Insulin Therapy in the Medical ICU · New England Journal of Medicine · 2006 · 2,868 citations
• Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes · New England Journal of Medicine · 2008 · 2,837 citations
• Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis · New England Journal of Medicine · 2008 · 2,348 citations
• Activation of Oxidative Stress by Acute Glucose Fluctuations Compared With Sustained Chronic Hyperglycemia in Patients With Type 2 Diabetes · JAMA · 2006 · 2,090 citations

Most recent work

• Persistent stress hyperglycemia trajectories predict mortality in sepsis: a machine learning-enhanced cohort study · BMC Infectious Diseases · 2026
• Association of GLP-1 inhibitors with cardiovascular outcomes in patients undergoing coronary artery bypass surgery · The Journal of Thoracic and Cardiovascular Surgery · 2026
• Feasibility of continuous glucose monitoring in an acute geriatric unit – the GLYCOGER study · BMC Geriatrics · 2026
• Associations between GLP 1 receptor agonist therapy and surgical wound healing in a high-risk cohort · medRxiv · 2026
• Threshold and Predictive Alerts of Continuous Glucose Monitoring and Glycemic Control in Hospitalized Adults With Diabetes · JAMA Network Open · 2026
• Uncontrolled Diabetes Mellitus in the Year Prior to Total Hip or Knee Arthroplasty Is Associated with Similar Perioperative Glucose Control, Early Complication Rates, and 5-Year Reoperation Rates after Preoperative Diabetes Mellitus Optimization · The Journal of Arthroplasty · 2026
• Glycemic Control and Utilization Risk With the Conversion of Glimepiride to Glipizide in Adults 64 Years and Older at an Integrated Health Care System · Journal of the American Geriatrics Society · 2026
• Prognostic value of stress hyperglycemia ratio in critically Ill patients with acute kidney injury: a machine learning-driven retrospective cohort analysis · Health Information Science and Systems · 2026
• Post-surgical DKA stems from poor glycemic control prior to surgery and perioperative catecholamine usage: unmatched case–control study · Perioperative Medicine · 2026
• Hypoglycemic Events Focusing on Situational Factors, Bystander Identification, and Prehospital Management · Journal of Clinical Medicine · 2026

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