Narrative reviewindependent cross-checkabstract checked★ key study I-DIAB-107 in-depth review
Is high blood sugar during severe illness protective?
Stress hyperglycemia: an essential survival response!
Overview
Marik PE, Bellomo R. Crit Care 2013 · PMID 23470218 · DOI 10.1186/cc12514
Critical-care experts argue that a short-term rise in sugar during severe illness may be a survival response; this does not apply to long-term diabetes.
Does the study support the specific claim? Partly · Methodological quality: low
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Argue that acute stress hyperglycaemia is adaptive.
- How was the study done?
Narrative review.
- How many people, animals or samples were studied?
Not applicable.
- What was actually found?
Tight ICU glucose control did not help; stress hyperglycaemia may be protective short term.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Brief high sugar in acute illness is not the same as diabetes.
- What are the study's limitations?
Opinion piece.
- What does it say about Elawady's specific claim?
Supports only the acute kernel of C-DIAB-01.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Cannot justify ignoring chronic high glucose.
Scientific in-depth review
1. Full reference
- Authors
- Marik PE, Bellomo R
- Journal
- Crit Care
- Year
- 2013
- Identifier
- PMID 23470218 DOI 10.1186/cc12514
- Verification
- verified – PubMed efetch 2026-10-26; Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Not stated in abstract.
2. Research question
Is stress hyperglycaemia in acute illness adaptive?
3. Study design and population
- Study design
- Narrative review – Narrative review/hypothesis paper
- Population
Critically ill patients
- Country
Not applicable
- Period
Literature to 2013
- Sample size
Not applicable
- Inclusion and exclusion criteria
Not systematic
4. Methods and endpoints
- Exposure / intervention
Stress hyperglycaemia in acute illness
- Comparator
Tight glycaemic control
- Endpoints
Pathophysiology; outcomes in ICU trials
- Statistical methods
Not applicable
5. Actual results
- Results
Stress hyperglycaemia is common in critical illness and a marker of severity; tight in-hospital glycaemic control has not improved outcomes; the authors propose that acute hyperglycaemia and insulin resistance are an evolutionarily preserved adaptive response and that interfering with it may be harmful.
- Absolute risks
not reported
- Authors' conclusion
Stress hyperglycaemia in acute illness may be adaptive.
6. Strengths
- Explicitly argues the adaptive view
- Cites ICU trial evidence
7. Weaknesses
- Narrative, opinion-based
- Concerns acute critical illness only, not chronic diabetes
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Opinion/review.
9. Assessment of the statistical interpretation
Not applicable.
10. Relevance to the specific claim
Closest scientific support for 'high sugar rescues you': it applies to short-term stress hyperglycaemia in acute illness (consistent with NICE-SUGAR, A-INS-02), not to chronic hyperglycaemia of diabetes.
11. Independent contrary findings
12. Transferability to Germany and Europe
Directly applicable; same biology and clinical standards in Europe.
13. Overall methodological judgement
Supports only the acute-stress kernel.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | low |
| Risk of bias | not assessable |
| Precision of results | not applicable |
| Directness | indirect |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | mixed |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |