American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control

• Published in: Diabetes care Vol. 32; no. 6; pp. 1119 - 1131
• Main Authors: Moghissi, Etie S, Korytkowski, Mary T, DiNardo, Monica, Einhorn, Daniel, Hellman, Richard, Hirsch, Irl B, Inzucchi, Silvio E, Ismail-Beigi, Faramarz, Kirkman, M. Sue, Umpierrez, Guillermo E
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01-06-2009
• Subjects: Blood Glucose - analysis; Blood Glucose - metabolism; Clinical trials; Consensus Development Conferences as Topic; Diabetes; Diabetes Mellitus - blood; Diabetes Mellitus - economics; Diabetics; Diseases; Endocrinology; Endocrinology - standards; Glycemic index; Hospitals; Humans; Hyperglycemia; Hyperglycemia - economics; Hyperglycemia - ethnology; Inpatients - statistics & numerical data; Medical research; Medical societies; Medicine, Experimental; Mortality; Reviews/Commentaries/ADA Statements; Societies, Medical - standards; Type 2 diabetes
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc09-9029

[...] recent trials in critically ill patients have failed to show a significant improvement in mortality with intensive glycemic control (12,13) or have even shown increased mortality risk (14). [...] these recent RCTs have highlighted the risk of severe hypoglycemia resulting from such efforts (12-17). A sixfold increase in severe hypoglycemic events (BG <40 mg/dl [2.2 mmol/1]) was observed in the intensively treated group (18.7 vs. 3.1%), and hypoglycemia was identified as an independent risk factor for mortality (16).\n * Less stringent targets may be appropriate in terminally ill patients or in patients with severe comorbidities. * Scheduled subcutaneous administration of insulin, with basal, nutritional, and correction components, is the preferred method for achieving and maintaining glucose control. * Prolonged therapy with SSI as the sole regimen is discouraged. * Noninsulin antihyperglycemic agents are not appropriate in most hospitalized patients who require therapy for hyperglycemia. * Clinical judgment and ongoing assessment of clinical status must be incorporated into day-to-day decisions regarding treatment of hyperglycemia.