Hospital management of hyperglycemia.

PURPOSE OF REVIEW

With the growing prevalence of dysglycemia, the increased frequency of hospitalizations in diabetic patients, and the notable effects of acute stress on glucose metabolism, it is not surprising that hyperglycemia is frequently encountered in the inpatient setting. Hospital hyperglycemia is associated with increased morbidity and mortality, as well as increased length of stay and costs. Accordingly, there has been intense interest in the optimal management of glucose levels in hospitalized patients. However, overly stringent control may result in hypoglycemia, which in itself is a risk factor for adverse clinical outcome. A fine balance in management is obviously important.

RECENT FINDINGS

We herein review recent observational studies and randomized clinical trials regarding glycemic management in the hospital, both in the critical care and noncritical care settings. Though results are conflicting, a consensus has recently emerged that although glucose control is important, prior recommendations had become too aggressive.

SUMMARY

Newly updated national guidelines call for a blood glucose target for critically ill patients of 140-180 mg/dl, using a continuous insulin infusion if needed. In the noncritically ill, a value less than 140 mg/dl before meals and less than 180 on random checks is recommended. A regimen of basal insulin in conjunction with premeal and supplemental insulin is preferred, as opposed to simple sliding scale insulin. Importantly, these guidelines are merely recommendations and management of the hyperglycemic inpatient must be tailored to suit the individual, considering their other comorbidities, risk factors for hypoglycemia, availability and training of hospital staff, and overall prognosis.