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

TLDR

We have labeled abstract lines: [Other] 4. [Purpose] Does inpatient management of hyperglycemia represent a safety concern? [Other] 5. [Purpose, Mechanism] What systems need to be in place to achieve these recommendations?6.Is treatment of inpatient hyperglycemia cost-effective?7.

Abstract

4. Does inpatient management of hyperglycemia represent a safety concern? 5. What systems need to be in place to achieve these recommendations?6.Is treatment of inpatient hyperglycemia cost-effective?7. 8. What are areas for future research? QUESTION 1: DOES IMPROVING GLYCEMIC CONTROL IMPROVE CLINICAL OUTCOMES FOR INPATIENTS WITHHYPERGLYCEMIA? -Hyperglycemia in hospitalized patients, irrespective of its cause, is unequivocally associated with adverse outcomes (5,6,18 -25).Hyperglycemia occurs in patients with known or undiagnosed diabetes, or it occurs during acute illness in those with previously normal glucose tolerance (termed "stress hyperglycemia") (8,26).Intervention directed at reducing blood glucose (BG) levels has resulted in improved outcomes in some, but not all, studies (5,18 -25).Several recent clinical trials in critically ill patients have reported no reduction in mortality from intensive treatment targeting near-euglycemia versus conventional management targeting BG Ͻ180 mg/dl (Ͻ10.0 mmol/l).Of considerable concern are reports of harm, with higher rates of severe hypoglycemia and even increased mortality (14) resulting from intensive glycemic control (12)(13)(14)16,27,28).This variability in results may be attributable to several factors, including differences in intravenous (IV) insulin treatment protocols and their implementation, glycemic targets, patient populations, methods for glucose monitoring, and insulin adjustment (12,29).The following section focuses primarily on results of recent studies with an RCT design that investigated patient outcomes with protocols targeting nearnormalization of BG levels.Readers are referred to a previous ACE position statement (9), an ACE/ADA consensus statement (11), and a technical review (8) for details related to earlier studies supporting inpatient glycemic management. What are the optimal strategies for transition to outpatient care? 8. What are areas for future research?