The American Association of Clinical Endocrinologists and the American Diabetes Association Joint Statement in Response to American College of Physicians (ACP) Clinical Guidelines for Inpatient Glucose Control

• The publication of the systematic review of intensive insulin therapy in hospitalized patients and the American College of Physicians (ACP) clinical guidelines for inpatient glucose control in the February 15th issue of Annals of Internal Medicine has again raised the issue of optimal management of hyperglycemia in the hospital.
• The American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) have published updated guidelines for treating high blood glucose while avoiding low blood glucose in hospitalized patients. The main objectives of the 2009 AACE/ADA recommendations were to identify reasonable, achievable, and safe glycemic targets and to describe the protocols, procedures, and system improvements needed to facilitate their implementation. For most patients a blood glucose target of 140-180 mg/dL is recommended and appropriate use of insulin is the preferred approach for achieving safe, optimal glucose control.
• There is substantial observational evidence linking hyperglycemia in hospitalized patients (with or without diabetes) to poor outcomes. Although initial small studies suggested that intensive glycemic control (insulin infusion with goal blood glucose targets of 80-110 mg/dl) improved outcomes in surgical ICU and medical ICU patients, subsequent trials have failed to show a benefit or have even shown increased mortality of intensive targets compared to more moderate targets (140-180 mg/dl). Moreover, these recent studies have highlighted the risk of severe hypoglycemia resulting from attempts to completely normalize blood glucose.
• The recent ACP guidelines are for the most part consistent with the AACE/ADA recommendations. AACE/ADA maintains that the upper limit of 180 mg/dl is safe and justified by data on benefits of glycemic control and the harms of uncontrolled hyperglycemia. Practitioners should take heart in the commonality of recommendations among all the organizations to address hospital hyperglycemia in the safest manner.

Read More on http://www.businesswire.com/news/home/20110216007059/en/Insulin-Therapy-Hospitalized-Patients-Abandoned