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American College of Physicians Issues Guideline for Use of Intensive Insulin Therapy for the Management of Glycemic Control in Hospitalized Patients

Recommendations are departure from current practice

PHILADELPHIA, February 15, 2011 -- Poorly controlled hyperglycemia is associated with increased illness, death, and worsening health outcomes in hospitalized patients. While most doctors make efforts to prevent and control hyperglycemia in hospital settings, the use of intensive insulin therapy and optimal blood glucose range to target in hospitalized patients has been uncertain.

In “Use of Intensive Insulin Therapy for the Management of Glycemic Control in Hospitalized Patients: A Clinical Practice Guideline from the American College of Physicians,” published in the February 15 issue of Annals of Internal Medicine, ACP makes three recommendations:

  • ACP recommends not using intensive insulin therapy to strictly control blood glucose in non-surgical intensive care unit (SICU) or non-medical intensive care unit (MICU) patients with or without diabetes.
  • ACP recommends not using intensive insulin therapy to normalize blood glucose in SICU or MICU patients with or without diabetes.
  • ACP recommends a target blood glucose level of 140 to 200 mg if insulin therapy is used in SICU or MICU patients.

“The evidence shows that targeting normal glucose levels of 80 to 110 mg in ICU patients does not lead to better outcomes,” said Amir Qaseem, MD, PhD, MHA, FACP, director of clinical policy for ACP. “Some studies showed an increase in death with intensive insulin therapy.”

While the evidence is not sufficient to give a narrower range for blood glucose levels, ACP says in the guideline, a target of 140 to 200 mg is a reasonable option in ICU patients because this range is associated with similar mortality outcomes as 80 to 110 mg blood glucose levels and is associated with a lower risk for hypoglycemia.

ACP’s recommendations are based on a systematic evidence review of an evidence report sponsored by the Department of Veterans Affairs.

About the American College of Physicians
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 130,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults. Follow ACP on Twitter and Facebook.

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