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Point: Inpatient Glucose Management

The emperor finally has clothes

¹ Gonda (Goldschmied) Diabetes Center, Division of Endocrinology, Diabetes and Hypertension, David Geffen School of Medicine at UCLA, Los Angeles, California
² Section of Endocrinology, West Los Angeles Veterans Administration Medical Center, Los Angeles, California
³ Division of Endocrinology, Baylor College of Medicine, Houston, Texas

Address correspondence to Michael Bryer-Ash, David Geffen School of Medicine at UCLA, Division of Endocrinology, Diabetes and Hypertension, 900 Veteran Ave., Suite 24-130, Los Angeles, CA 90095. E-mail: mbryerash@mednet.ucla.edu

The first 300 words of the full text of this article appear below.

In January 2004, a panel convened by the American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE) issued a position statement on the management of glucose in hospitalized patients (1). This panel included representation by the American Diabetes Association (ADA), the Endocrine Society, the American Heart Association, the Society of Critical Care Medicine, the Society of Thoracic Surgeons, The American Association of Diabetes Educators, The American Society of Anesthesiologists, and The Society of Hospital Medicine, all of whom were cosignatories to the ensuing document. The position statement recommended that a preprandial target level of 110 mg/dl (6.0 mmol/l) be set for the plasma glucose level of all hospitalized patients, regardless of the presence or absence of a prior diagnosis of diabetes (1).

The impetus for establishment of a position on this issue largely arose from the publication of two major prospective controlled intervention trials that demonstrated significant reductions in serious morbidities and mortality in hospitalized patients in whom glycemia was tightly regulated (2,3). These trials were in turn undertaken to further address the findings of prior observational studies, which showed a strong correlation between hyperglycemia and poor clinical outcomes in a variety of inpatient settings (4–8). Until recently, it seemed intuitively obvious that hyperglycemia manifested under physiologically stressful situations was a consequence of the primary illness and a marker of its severity, rather than directly contributing additional morbidity to it. While the former may indeed be the case, it came as a surprise to many that prospective trials addressing the hyperglycemia alone, or to be more specific, addressing it by the administration of insulin, improved multiple immediate clinical outcomes, including reducing sepsis, renal failure, transfusion requirements, and polyneuropathy (3,9). Moreover, . . . [Full Text of this Article]

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Point-Counterpoint

Counterpoint: Inpatient Glucose Management: A premature call to arms?

Silvio E. Inzucchi and Julio Rosenstock
Diabetes Care 2005 28: 976-979. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				S. E. Inzucchi Management of Hyperglycemia in the Hospital Setting N. Engl. J. Med., November 2, 2006; 355(18): 1903 - 1911. [Full Text] [PDF]