Overview
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There is an increasing awareness throughout the medical community of the need to control blood glucose (BG) levels in order to optimize outcomes in the hospital setting. Studies in critical care medicine,1 acute myocardial infarction (AMI),2 and cardiac surgery3 demonstrate a strong association between hyperglycemia and morbidity and mortality among patients in intensive care units.4 Hyperglycemia has multiple causes in this patient population, including stress, decompensation of type 1 or type 2 diabetes mellitus, and iatrogenic factors such as the administration of pharmacologic agents, such as glucocorticoids and vasopressors. A landmark randomized clinical trial has demonstrated a clear improvement in outcomes with intensive glucose control in the intensive-care unit (ICU) setting where BG in the intensive-control arm resulted in mean BG of 103 mg/dL.1
When hyperglycemia is treated along with the presenting acute illness, outcomes are generally improved.4,5 This has resulted in the recent publication of guidelines for glucose targets in the hospital management of diabetes. The guidelines recommend upper-limit BG targets of 110 mg/dL (6.1 mmol/L) for ICUs and 110 mg/dL to 180 mg/dL in non–critical-care units.6 The recommendations have broad-based support from the scientific and clinical communities. The American College of Endocrinology sponsored the consensus conference that led to this position statement, cosponsored by the American Diabetes Association, the American Heart Association, the American Society of Anesthesiologists, the Society of Critical Care Medicine, the Society of Hospital Medicine, the Society of Thoracic Surgeons, and the Endocrine Society, with the American College of Cardiology as a participating organization. These guidelines are intended to provide clinicians with broadly defined glucose targets for promoting improved outcomes in the hospital setting.
To attain glycemic control in the hospital, insulin is the therapy most commonly and appropriately administered. This eGrand Rounds includes 2 case studies and a review of the rationale and strategies for attaining targeted glucose control in the hospital management of diabetes and hyperglycemia.
