During the last 2 decades, the treatment of
hyperglycemia in
critically ill patients has become one of the most discussed topics in the intensive medicine field. The initial data suggesting significant benefit of normalization of
blood glucose levels in
critically ill patients using intensive intravenous
insulin therapy have been challenged or even neglected by some later studies. At the moment, the need for
glucose control in
critically ill patients is generally accepted yet the target
glucose values are still the subject of ongoing debates. In this review, we summarize the current data on the benefits and risks of tight
glucose control in
critically ill patients focusing on the novel technological approaches including continuous
glucose monitoring and its combination with computer-based algorithms that might help to overcome some of the hurdles of tight
glucose control. Since increased risk of
hypoglycemia appears to be the major obstacle of tight
glucose control, we try to put forward novel approaches that may help to achieve optimal
glucose control with low risk of
hypoglycemia. If such approaches can be implemented in real-world practice the entire concept of tight
glucose control may need to be revisited.