壓力性高血糖症( Stress induced hyperglycemia) 是重症病患產生高血糖的主要原因。其主要機轉為：「內生性荷爾蒙調控作用」以及「細胞激素導致的胰島素阻抗作用」。過去的研
究顯示血糖過高會影響病患存活率。從2001 年新英格蘭雜誌Leuven study 提出嚴格控制血糖
( 控制在80-110 mg/dL) 可以改善外科重症病患的死亡率達34%後，近十年來，關於重症病患、敗血症病患之嚴格血糖控制是否影響預後的大型研究方興未艾。然而，重症病患之血糖究竟
該控制到什麼程度、敗血症患者該如何控制血糖？卻仍有爭議。本文係針對2001-2010 年嚴
格控制血糖(80-110 mg/dL) 的大型研究進行文獻回顧。2006 年Leuven study 探討內科加護病房的血糖控制，揭開了嚴格血糖控制在內外科病患影響差異的爭議; 2008 de la Rosa G study、2008 Arabia study 將內外科病患一起探討，其結果並不支持嚴格血糖控制可以降低病患死亡率。多中心前瞻性的血糖控制研究有2009 Glucontrol study 以及2009 NICE-SUGAR study，顯示嚴格控制血糖反而可能有較高死亡率及嚴重低血糖症發生率。針對敗血症病患的研究(2008VISEP study 及2010 COIITSS study) 也發現：「敗血症病患接受嚴格血糖控制並不會降低住院死亡率」。結論是：「重症患者的嚴格血糖控制對存活率的影響仍有爭議」; 「嚴重敗血症急重症患者的建議血糖應控制在150-180 mg/dL」;「嚴格控制血糖在80-110 mg/dL 容易使重症及敗血症患者顯著產生嚴重低血糖症(<40 mg/dL) 的風險」。

Stress-induced hyperglycemia, caused by excessive counter- regulatory hormones and cytokines induced insulin resistance, is a common phenomenon in critically ill patients. Hyperglycemia and insulin resistance are
also associated with increased mortality. Accordingly, control of hyperglycemia in sepsis and critically ill patients is suggested to be a very effective therapeutic approach. However, randomized trials of intensive insulin therapy have reported inconsistent effects on mortality and increased rates of severe hypoglycemia significantly. In 2001,
with the publication of the Leuven study revealed tight sugar control (blood sugar controlled within range of 80-110mg/dL) was associated with reduction in the mortality and morbidity of critically ill patients in surgical intensive care units, there has been substantial growing interest in glycemic control among these patients. Subsequent trials (2006 Leuven study, 2008 de la Rosa G study and 2008 Arabia study) have failed to confirm a mortality benefit with intensive insulin therapy among critically ill patients. The findings of 2009 Glucocontrol study and the NICE-SUGAR study investigators even highlight that tight glucose control in the critically ill patients might actually increase morality and the events of severe hypoglycemia significantly. For the study of patients with sepsis (2008VISEP Study and the 2010 COIITSS Study) also found that "sepsis patients underwent strict glycemic control does
not reduce hospital mortality." In this article, we gave an overview to update the totality of evidence regarding the influence of intensive insulin therapy compared with conventional insulin therapy on mortality and severe hypoglycemia in the intensive care unit. In addition, we summarized the current practical guideline of glucose control for
physicians in treating these septic and critically ill patients. The conclusions of sugar control in critically ill patients are "the survival benefits of intensive insulin control in critically ill patients remains controversial"; the optimal levels of blood sugar for sepsis and critically ill patients are within the ranges of 150-180 mg/dL"; "strict control of blood glucose in 80-110 mg/dL increased the risk of severe hypoglycemia