ACP issues guideline for intensive insulin therapy in hospitalized patients

The American College of Physicians (ACP) recently issued 3 recommendations for use of intensive insulin therapy for the management of glycemic control in hospitalized patients. The ACP guideline, published in the Annals of Internal Medicine, seeks to end uncertainty regarding the therapy and the optimal glucose range to target in these patients.

The ACP guideline contains the following recommendations:

• Intensive insulin therapy should not be used to strictly control blood glucose in non-surgical intensive care unit (SICU) or non-medical intensive care unit (MICU) patients with or without diabetes

• Intensive insulin therapy should not be used to normalize blood glucose in SICU or MICU patients with or without diabetes

• If insulin therapy is used in SICU or MICU patients, there should be a target blood glucose level of 140 to 200 mg/dL

“The evidence shows that targeting normal glucose levels of 80 to 110 mg/dL in ICU patients does not lead to better outcomes," said Amir Qaseem, MD, PhD, MHA, FACP, director of clinical policy for ACP.  "Some studies show an increase in death with intensive insulin therapy.”

While the evidence is not sufficient to give a narrower range for blood glucose levels, a target of 140 to 200 mg/dL is a reasonable option in ICU patients because this range is associated with similar mortality outcomes as 80 to 110 mg/dL blood glucose levels and is associated with a lower risk for hypoglycemia, according to the ACP.