Management of Inpatient Hyperglycemia

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Investigators: Devan Kansagara, MD, Fawn Wolf, MD, Michele Freeman, MPH, and Mark Helfand, MD, MPH. Portland Veterans Affairs Healthcare System, Oregon Evidence-based Center Washington (DC): Department of Veterans Affairs; October 2008.

Download PDF: Complete Report, Executive Summary, Report, Appendices

Summary / Overview

Hyperglycemia is a common finding in hospitalized patients and has been associated with worsened outcomes in a variety of inpatient subpopulations. The use of insulin to control blood glucose has been advocated as a way to improve health outcomes in hospitalized patients with hyperglycemia, but the evidence for the efficacy of this approach and the thresholds for initiating insulin management are unclear.

The key questions were:

1. Does strict blood glucose control compared to less strict blood glucose control improve final health outcomes in the following patients?
   • patients in the medical intensive care unit
   • patients in the surgical intensive care unit
   • acute myocardial infarction patients
   • acute stroke patients
   • post coronary artery bypass graft patients
   • general surgical ward patients
   • general medicine ward patients
2. What are the harms of strict blood glucose control in the above subpopulations?
3. What are the most effective and safest means of normalizing blood glucose in the above subpopulations?

See also

• Appendix D (87 KB, MS Excel)
• Appendix E (81 KB, MS Excel)

Synthesis of the Evidence on Inpatient Hyperglycemia Management Finds Intensive Insulin Therapy Does Not Clearly Improve Health Outcomes (VA HSR&D Management e-Brief) (76 KB, PDF)

Kansagara D, Fu R, Freeman M, Wolf F, Helfand M. Intensive insulin therapy in hospitalized patients: a systematic review. Ann Intern Med. 2011 Feb 15;154(4):268-282.