ACP Issues Guidelines for Glycemic Control in Hospitalized Patients

The American College of Physicians provides three recommendations for the use of intensive insulin therapy to manage glycemic control in hospitalized patients.

Poorly controlled hyperglycemia is associated with increased illness, death, and worsening health outcomes in hospitalized patients. While most physicians make efforts to prevent and control hyperglycemia in hospital settings, the use of intensive insulin therapy and optimal blood glucose range to target in hospitalized patients has been uncertain.

In an article published in the Annals of Internal Medicine, the American College of Physicians provides clinical practice guidelines for the use of intensive insulin therapy (IIT) for the management of glycemic control.

The three recommendations listed by Amir Qaseem, MD, PhD, MHA and colleagues are as follows:

  • ACP recommends not using intensive insulin therapy to strictly control blood glucose in non-surgical intensive care unit (SICU) or non-medical intensive care unit (MICU) patients with or without diabetes.
  • ACP recommends not using intensive insulin therapy to normalize blood glucose in SICU or MICU patients with or without diabetes.
  • ACP recommends a target blood glucose level of 140 to 200 mg if insulin therapy is used in SICU or MICU patients.

“The evidence shows that targeting normal glucose levels of 80 to 110 mg in ICU patients does not lead to better outcomes,” said Qaseem, who is director of clinical policy for ACP, in a press release. “Some studies showed an increase in death with intensive insulin therapy.”

While the evidence is not sufficient to give a narrower range for blood glucose levels, ACP says in the guideline, a target of 140 to 200 mg is a reasonable option in ICU patients because this range is associated with similar mortality outcomes as 80 to 110 mg blood glucose levels and is associated with a lower risk for hypoglycemia.

The guideline, the authors point out, refers to hospitalized patients with hyperglycemia. Physicians should be aware that “critically ill medical and surgical patients who are hyperglycemic have a higher mortality rate.”

Most clinicians, they noted, agree that prevention of hyperglycemia is an important intervention. The range of optimal glucose level, however, is controversial. Although a few studies show that IIT improves mortality, most have shown that patients who receive IIT have no reduction in mortality and have a significantly increased risk for severe hypoglycemia.

To access a full summary of the ACP recommendations and clinical considerations, click here.