American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control
- Etie S. Moghissi, MD, FACP, FACE1,
- Mary T. Korytkowski, MD2,
- Monica DiNardo, MSN, CRNP, CDE3,
- Daniel Einhorn, MD, FACP, FACE4,
- Richard Hellman, MD, FACP, FACE5,
- Irl B. Hirsch, MD6,
- Silvio E. Inzucchi, MD7,
- Faramarz Ismail-Beigi, MD, PHD8,
- M. Sue Kirkman, MD9 and
- Guillermo E. Umpierrez, MD, FACP, FACE10
- 1Department of Medicine, University of California, Los Angeles, Los Angeles, California;
- 2Department of Medicine, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania;
- 3Division of Endocrinology and Metabolism, Veterans Affairs Pittsburgh Health Center and University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania;
- 4Scripps Whittier Diabetes Institute, La Jolla, California, University of California San Diego School of Medicine, San Diego, California, and Diabetes and Endocrine Associates, La Jolla, California;
- 5Department of Medicine, University of Missouri-Kansas City School of Medicine, and Hellman and Rosen Endocrine Associates, North Kansas City, Missouri;
- 6Department of Medicine, University of Washington School of Medicine, Seattle, Washington;
- 7Department of Medicine, Section of Endocrinology, Yale University School of Medicine, and the Yale Diabetes Center, Yale-New Haven Hospital, New Haven, Connecticut;
- 8Department of Medicine, Physiology and Biophysics, Division of Clinical and Molecular Endocrinology, Case Western Reserve University, Cleveland, Ohio;
- 9Clinical Affairs, American Diabetes Association, Alexandria, Virginia,
- 10Department of Medicine/Endocrinology, Emory University, Atlanta, Georgia.
- Corresponding author: Dr. Etie S. Moghissi, .
People with diabetes are more likely to be hospitalized and to have longer durations of hospital stay than those without diabetes. A recent survey estimated that 22% of all hospital inpatient days were incurred by people with diabetes and that hospital inpatient care accounted for half of the 174 billion USD total U.S. medical expenditures for this disease (1). These findings are due, in part, to the continued expansion of the worldwide epidemic of type 2 diabetes. In the U.S. alone, there are ∼1.6 million new cases of diabetes each year, with an over all prevalence of 23.6 million people (7.8% of the population, with one-fourth of the cases remaining undiagnosed). An additional 57 million American adults are at high risk for type 2 diabetes (2). Although the costs of illness-related stress hyperglycemia are not known, they are likely to be considerable in light of the poor prognosis of such patients (3–6).
There is substantial observational evidence linking hyperglycemia in hospitalized patients (with or without diabetes) to poor outcomes. Cohort studies as well as a few early randomized controlled trials (RCTs) have suggested that intensive treatment of hyperglycemia improved hospital outcomes (5–8). In 2004, this evidence led the American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE), in collaboration with the American Diabetes Association (ADA) and other medical organizations, to develop recommendations for treatment of inpatient hyperglycemia (9). In 2005, the ADA added recommendations for treatment of hyperglycemia in the hospitalto itsannual Standards of Medical Care (10). Recommendations from the ACE and the ADA generally endorsed tight glycemic control in critical care units. For patients in general medical and surgical units, where RCT evidence regarding treatment targets was lacking, glycemic goals similar to those advised for outpatients were advocated (9, …