Diabetes experts issue new recommendations for inpatient glycemic
28 May 2009
New recommendations by a consensus group of the American Association
of Clinical Endocrinologists (AACE) and the American Diabetes
Association (ADA) are calling for major changes in the way healthcare
professionals treat hospitalized patients with high blood glucose
The authors recommend revised glucose targets of 140-180 mg/dL in the
ICU setting, and between 100-180 mg/dL for most patients admitted to
general medical-surgical wards.
The recommendations, which were published online and will appear in
the June issues of Endocrine Practice and Diabetes Care,
come at a time when attempts to intensively manage glucose targets in
the ICU setting have shown inconsistent results in patient outcomes.
Several recent randomized controlled clinical trials in critically
ill patients in ICUs with diabetes or elevated blood glucose levels have
failed to show a significant improvement in mortality with intensive
insulin therapy to achieve near normal glucose levels.
Moreover, a large newly-published randomized controlled trial showed
an increase in mortality risk associated with intensive control of
glycemia targeting blood glucose of 80-110 mg/dL. These outcomes have
raised concerns regarding specific glycemic targets and the means for
achieving them in both critically and non-critically ill patients.
Recognizing the importance of glycemic control across the continuum
of care, experts from AACE and ADA were invited to develop an updated
consensus statement on inpatient glycemic management.
After a thorough analysis of all the published trials, the authors
believe that patients with elevations in blood glucose should continue
to be carefully treated, but to less intensive blood glucose targets
than were previously suggested. The authors recommend revised glucose
targets of 140-180 mg/dL for critically ill patients in ICU settings.
"We are witnessing an evolution in the management of hyperglycemia in
inpatient settings," Dr Etie S Moghissi, AACE Chair of the Inpatient
Glycemic Control Consensus Panel said. "Despite some inconsistencies in
the clinical trial results, it would be a serious error to conclude that
judicious control of glycemia in hospitalized patients is not
The complexity of inpatient glycemic management necessitates a system
approach that facilitates safe practices that reduce the risk for errors
and episodes of severe hypoglycemia. The consensus group recommends a
multidisciplinary approach for care from admission to discharge from the
"The responsibility for management of hyperglycemia shifts from the
health care team to the patient following hospital discharge," said Dr
Mary Korytkowski, ADA Chair of the Inpatient Glycemic Control Consensus
Panel. "It is therefore important that patients receive the information
necessary to safely manage this aspect of their care once they are at
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