Recent trials investigating the effects of strict glucose regulation in critically ill patients have shown impressive reductions in morbidity and mortality. Although the literature focuses on the possible toxic effects of high blood glucose levels, the underlying mechanism for this improvement is unclear. We hypothesise that strict glucose regulation results in modulation of cytokine production, leading to a shift towards a more anti-inflammatory pattern. This shift in the cytokine balance accounts for the reduction in morbidity and mortality. To support our hypothesis, effects of glucose and insulin on cytokine release and effects of glucose, insulin, and cytokines on host defence, cardiac function and coagulation will be reviewed.
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Chronic kidney disease (CKD) attributed to diabetes, termed diabetic kidney disease (DKD), is increasing with the rising global prevalence of diabetes. Patterns of DKD onset and progression have shifted in recent years because of population aging and advances in the treatment of diabetes. Prevention of the onset and progression of micro/macro-albuminuria is possible through comprehensive and strict management of lifestyle, blood glucose, blood pressure, and lipids in people with diabetes and early DKD.
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