Inpatient glycemic control: best practice advice from the Clinical Guidelines Committee of the American College of Physicians

Abstract

Hyperglycemia is associated with poor outcomes in hospitalized medical and surgical patients. Although some early evidence showed benefits of intensive insulin therapy (IIT), recent evidence does not show a consistent benefit and even shows harm associated with the use of IIT. The overuse of some therapeutic interventions and the resulting harms to a patient are an important component of unnecessary health care costs. The goal of this article is to address the management of hyperglycemia and evaluate the benefits and harms associated with the use of IIT to achieve tight glycemic control in hospitalized patients with or without diabetes mellitus. This article is based on the evidence review and the guideline developed by the American College of Physicians on this topic. Best Practice Advice 1: Clinicians should target a blood glucose level of 7.8 to 11.1 mmol/L (140 to 200 mg/dL) if insulin therapy is used in SICU/MICU patients. Best Practice Advice 2: Clinicians should avoid targets less than 7.8 mmol/L (<140mg/dL) because harms are likely to increase with lower blood glucose targets.

Keywords: blood glucose level; high-value care; inpatient glycemic control; intensive insulin therapy.