Management of hyperglycemia in hospitalized patients

• Authors: Dawn Smiley, Emory University; Guillermo Umpierrez, Emory University
• Journal Title: Annals of the New York Academy of Sciences
• Volume: Volume 1212
• Publisher: New York Academy of Sciences | 2010-11, Pages 1-11
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1111/j.1749-6632.2010.05805.x
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: inpatient hyperglycemia; guidelines; intensive care unit; general wards; hypoglycemia

Abstract

Hyperglycemia is a common occurrence in hospitalized patients, and several studies have shown a strong association between hyperglycemia and the risk of complications, prolonged hospitalization, and death for patients with and without diabetes. Past studies have shown that glucose management in the intensive care setting improves clinical outcomes by reducing the risk of multiorgan failure, systemic infection, and mortality, and that the importance of hyperglycemia also applies to noncritically ill patients. Based on several past observational and interventional studies, aggressive control of blood glucose had been recommended for most adult patients with critical illness. Recent randomized controlled trials, however, have shown that aggressive glycemic control compared to conventional control with higher blood glucose targets is associated with an increased risk of hypoglycemia and may not result in the improvement in clinical outcomes. This review aims to give an overview of the evidence for tight glycemic control (blood glucose targets <140 mg/dL), the evidence against tight glycemic control, and the updated recommendations for the inpatient management of diabetes in the critical care setting and in the general wards.