Inpatient Glycemic Control Through the Eyes of AACE and ADA: Part 2

In part 1 of this series, we provided answers to questions regarding the safety and improvement of inpatient glycemic control. Today, we will address recommended glycemic targets and how to achieve those targets.

What glycemic targets can be recommended in different patient populations?

Different glycemic targets are advised for different patient scenarios. For example, glucose targets are higher for patients in the hospital setting than they are for patients with diabetes outside of the hospital. The target range also fluctuates when treating hyperglycemia in critically ill patients. The range recommended by the AACE and ADA starts with a threshold of 180 mg/dL, and once insulin therapy begins the target range should be between 140 and 180 mg/dL. While treating hyperglycemia in non-critically ill patients, the pre-meal glucose target range should be <140 mg/dL while safely achieving blood glucose values of <180 mg/dL.

What treatment options are available for achieving optimal glycemic targets safely and effectively in specific clinical situations?

• Intravenous(IV) Insulin – IV insulin allows quick dosing adjustments to reflect any changes in the patient’s status.
• Subcutaneous (SubQ) Insulin –  SubQ insulin is administered with recommended insulin components of a basal, nutritional, and supplemental element.

According to ADA, insulin therapy is the preferred method for achieving glycemic control in most clinical situations. Particularly, IV infusion is the preferred method of obtaining insulin in the ICU, and Subcutaneous insulin is the preferred glucose-control method in non-ICU patients with diabetes.

What systems need to be in place to achieve these recommendations?

In order to achieve safe glycemic control, a hospital should adopt a glycemic management solution and transition away from traditional, yet dated, approaches to glycemic management. Adoption of such program can provide significant cost savings with reductions in length of stay, need for readmission, and morbidity. This change will reduce the risk of errors and in turn, provide better care for a lower cost, but is dependent on the hospital administration adequately training and encouraging the staff.

In part 3 of this series, we will explain the cost effectiveness of treatment and optimal strategies for the transition to outpatient care.