There is now widespread appreciation of the importance of maintaining glucose levels as close to the normal range as possible among outpatients with diabetes. However, the importance of tight glucose control in inpatients is less well established. During the past several years, it has become apparent that hyperglycemia in hospitalized patients, especially those in the postoperative setting, is associated with poorer outcomes. In addition, two randomized trials have shown improved outcomes with intensive glucose management in acutely ill patients. Based on these studies and our own experience, we propose guidelines and a framework for improving the glycemic control of hospitalized patients.