Some experts recommend LESS intensive blood-glucose lowering in hospitalized patients. Hyperglycemia in hospitalized patients can be caused by either diabetes or stress and is associated with higher mortality.
Many guidelines recommend intensive glucose control in hospitalized patients especially in critical care patients. But new evidence shows a higher mortality in ICU patients treated to an average blood glucose of 115 mg/dL (6.4 mmol/L) compared to 144 mg/dL (8 mmol/L). This comes from the "NICE-SUGAR" trial. The absolute risk of death increases from 24.9% to 27.5% with intensive glucose control. This works out to one additional death for every 38 ICU patients treated for 90 days. The mortality may be due to an increased risk of hypoglycemia that might lead to more cardiovascular events. Good glucose control in the hospital is still important. But the goals may need to be less intensive in some patients. Consider following these NEW inpatient glucose goals...
Critical care patients. Suggest a goal of 140 to 180 mg/dL (7.8 to 10 mmol/L) for most patients. Explain lower goals are okay for some patients, such as bypass surgery patients or those getting total parenteral nutrition. Be more careful with targets less than 110 mg/dL (6.1 mmol/L) because of an increased risk of hypoglycemia.
Noncritically ill patients. Suggest a glucose level less than 140 mg/dL (7.8 mmol/L) before meals and a random glucose under 180 mg/dL (10 mmol/L). But keep in mind to individualize goals. Suggest LESS intensive treatment for patients who are terminally ill or have severe comorbidities. Suggest MORE intensive treatment for stable patients who have previously done well with tight glycemic control.
REFERENCES
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NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson WR, Hébert PC, Heritier S, Heyland DK, McArthur C, McDonald E, Mitchell I, Myburgh JA, Norton R, Potter J, Robinson BG, Ronco JJ. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009 Mar 26;360(13):1283-97. Available at: https://www.nejm.org/doi/10.1056/NEJMoa0810625?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200www.ncbi.nlm.nih.gov
Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, Hirsch IB; American Diabetes Association Diabetes in Hospitals Writing Committee. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004 Feb;27(2):553-91. Available at: https://diabetesjournals.org/care/article/27/2/553/28286/Management-of-Diabetes-and-Hyperglycemia-in