Acute GIycemic Control in Hospitalized Patients: Evidence Published Since the American College of Endocrinology Position Statement

Background: In a 2004 position statement, the American College of Endocrinology (ACE) recommended that the plasma glucose level be ≤110 mg/dL (fasting) and <180 mg/dL (postprandial) for hospitalized patients not in the intensive care unit (ICU) and 80 to 110 mg/dL for hospitalized patients in the ICU, whether or not they had documented diabetes mellitus. Objective: This paper reviews published studies on this topic, with focus on those appearing after the ACE statement. Methods: Relevant studies were identified by a MEDLINE search of references and studies and by extensive familiarity with the topic. Results: The results of observational studies have been mixed and are complicated by uncertainty as to whether hyperglycemia is simply a marker of illness severity or is causally related to adverse clinical outcome. Conclusions: Intriguing evidence from randomized controlled trials suggests that tight glycemic control in the hospitalized patient improves mortality and morbidity, although the above-recommended glucose target values have not been met in some studies.