The degree of hyperglycemia may be an important predictor of morbidity and mortality among patients with MI or stroke, and in those undergoing surgical procedures including coronary artery bypass. Hyperglycemia should be aggressively controlled from the time of hospital admission regardless of the patient's primary medical problem or previous diabetes status. Innovative systems for monitoring glucose and for delivering insulin coupled with new pharmacologic therapy, such as long-acting insulin analogues, may help reduce the morbidity and mortality occurring in the estimated 6 million annual hospitalizations that are accompanied by hyperglycemia in the United States.