Guidelines Set for Insulin Therapy in Hospital Setting

Tight glycemic control seems to serve no benefit over less strict control

FRIDAY, Feb. 18 (HealthDay News) -- The American College of Physicians has established guidelines for insulin therapy in hospitalized patients with or without diabetes, and another group of researchers has determined that there are no benefits for achieving strict glycemic control rather than less strict control in hospitalized patients; both articles have been published in the Feb. 15 issue of the Annals of Internal Medicine.

Amir Qaseem, M.D., Ph.D., of the American College of Physicians in Philadelphia, and colleagues conducted a literature review to provide practice guidelines for intensive insulin therapy (IIT) to achieve different glycemic targets in hospitalized patients. They recommend not using IIT to strictly control blood glucose or to normalize blood glucose in non-surgical intensive care unit/medical intensive care unit (SICU/MICU) patients with or without diabetes. When insulin therapy is used for SICU/MICU patients, the blood glucose level should be kept to 140 to 200 mg/dL, according to the recommendations.

Devan Kansagara, M.D., of the Oregon Health & Science University in Portland, and colleagues conducted a literature review in an evaluation of the benefits and harms of using IIT titrated to strict glycemic targets in hospitalized patients. They found no consistent evidence of benefit from IIT targeted to strict glycemic control as opposed to less strict control. They did find that IIT is related to an increased risk of severe hypoglycemia.

"Most of these trials were small, single-center studies conducted in ICU or surgical settings. This fact may limit the generalizability of findings, especially to general medical ward settings," Kansagara and colleagues conclude.

One author of the first article disclosed a financial relationship with Pfizer.

Abstract - Qaseem
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Abstract - Kansagara
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