Diabetes experts issue new recommendations for inpatient glycemic control

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 (sugar) levels.

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 warranted."

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 hospital.

"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 home."

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