COMMENTARY

New Guideline Sets Higher Hospital Glycemia Targets

Anne L. Peters, MD, CDE

Disclosures

March 01, 2011

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Hi. I'm Dr. Anne Peters, and today I'm going to discuss the new guidelines from the American College of Physicians[1] on glycemic targets for hospitalized patients. These guidelines suggest higher targets than we have used in the past. They suggest keeping the blood glucose level in the range of 140-200 mg/dL in patients who are in the hospital. This applies to patients who have hyperglycemia due to acute illness as well as those with pre-existing diabetes.

Where did these guidelines come from? In the same issue of the Annals of Internal Medicine, there is a large meta-analysis[2] that looked at the effects of tight glycemic control on hospitalized patients. This meta-analysis included 21 clinical trials and approximately 15,000 hospitalized patients who were treated either intensively or less intensively with comparable outcomes.

What this meta-analysis showed is that when you look across all of these studies, no significant benefit was found for tight glycemic control on a whole variety of important factors such as mortality, sepsis, infection, duration of time in the intensive care unit, duration of time in the hospital, etc. In some of the trials, a trend towards improvement was seen, but overall no clear benefit to tight glycemic control in hospitalized patients was evident.

What they did find throughout all of the trials was an increased risk for both mild and severe hypoglycemia. Because this risk for hypoglycemia could potentially be associated with harm, the conclusion that was drawn from this meta-analysis was that our target should be higher, in the range of 140-200 mg/dL in most patients.

Obviously, this doesn't mean that we can't and shouldn't individualize care, and there may be circumstances where it is felt that tighter glycemic control is indicated, but on the basis of this meta-analysis, the American College of Physicians came out with these new guidelines. It's appropriate to avoid tight glycemic control in hospitalized patients or at least not intensively treat hospitalized patients because of the risk for development of both severe and mild hypoglycemia. This has been Dr. Anne Peters for Medscape. Thank you.

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