At a February 2006 press conference, the Consensus Development Conference
sponsored by the American Association of Clinical Endocrinologists and
the American Diabetes Association called for action on glycemic control
and said, “Structured protocols for aggressive control of blood sugar
in both intensive care units and other hospital settings should be implemented.”
“Tight glycemic control (TGC) improves mortality and morbidity, and reduces
cost,” the panel said, noting that hyperglycemia is an independent risk
factor for poor clinical outcome in multiple patient populations, and
hospitalization is an opportunity to assess glycemic control and intensify
the outpatient therapy
In addition to calling for structured protocols for glycemic control,
the consensus committee said:
- It strongly recommends identifying elevated blood sugars in all hospitalized
- Hyperglycemia must be treated vigorously as soon as it is detected,
to improve medical and surgical outcomes.
- A multidisciplinary team approach to diabetes management should be
created in all hospitals.
- Educational programs for all hospital personnel caring for people
with diabetes are an essential component of successful treatment.
- Successful protocols for intensive glycemic control are available
for intravenous insulin for use in intensive care units and other hospital
- When subcutaneous insulin is used, it should be done in the most physiologic
way possible to achieve the best control.
- The consensus committee is aware that hypoglycemia (low blood sugar)
may be unavoidable as a result of aggressive treatment, but that it
is usually mild, transient, and easily treated, and harm can be avoided,
particularly when structured care plans are in place.
- Implementation of the consensus recommendations will improve patient
- The committee strongly recommends planning for a smooth transition
to outpatient care with appropriate diabetes management.
- The consensus committee recommends that the National Diabetes Quality
Alliance develop performance measures for inpatient management of hyperglycemia
and submit the measures to the National Quality Forum for the approval
process which establishes these measures as standards for the nation.
For more information about the Consensus Conference on “Inpatient Diabetes
and Glycemic Control,” see www.aace.com
Anne Paxton is a writer in Seattle.