ACP issues high-value care recommendations for inpatient glucose management

Intensive insulin therapy (IIT) for inpatient glycemic control can result in more harm than benefit, ACP's Clinical Guidelines Committee recently reminded clinicians in a best practice advice paper.

ACP recommends that clinicians should target a blood glucose level of 140 to 200 mg/dL if IIT is used in surgical or medical intensive care unit patients, and clinicians should avoid targets less than 140 mg/dL because harms are likely to increase with lower blood glucose targets, noted the paper, published in the American Journal of Medical Quality on May 23.

In a review of the evidence, ACP's Clinical Guidelines Committee found that IIT with a goal of achieving normal or near-normal blood glucose in patients with or without diabetes does not provide substantial benefits and may lead to harm. IIT costs include implementation in a hospital and downstream expenses incurred to manage the consequent harms. No recent cost-effectiveness studies have incorporated results from recent trials to evaluate the impact of IIT.

“Even in light of the new evidence, many systems continue to recommend moderate blood glucose control because of the association of high blood glucose with infection, poor wound healing, dehydration, and other complications. Clinicians caring for these patients must keep the harms of hypoglycemia in mind when managing hyperglycemia and should avoid aggressive glucose management,” the ACP experts wrote.