DeSantis AJ et al. (2006) Inpatient management of hyperglycemia: the Northwestern experience. Endocr Pract 12: 491–505

In spite of the fact that about one-quarter of hospitalized individuals suffer from hyperglycemia, which is associated with numerous adverse effects, there are no standardized treatment strategies for glycemic control in hospitalized patients. DeSantis and colleagues report the results achieved by two protocols—based on either intravenous or subcutaneous insulin—developed for patients at a tertiary-care hospital in Chicago. Educational sessions and step-by-step instructions (including conversion tables) for nurses were essential elements of both protocols that were closely monitored by a 'glucose-management team'.

The intravenous-insulin protocol aimed to achieve target blood glucose levels of between 80 and 110 mg/dl, and was used in 276 critically ill patients. The insulin drip rate was adjusted according to the capillary blood glucose level, which was recorded at least every 2 h. In patients treated with intravenous insulin, the mean capillary blood glucose level was 135.3 mg/ml. Hypoglycemia was recorded in 1.5% of 4,058 blood glucose measurements, and hyperglycemia in 0.06%.

The subcutaneous-insulin protocol was followed in 922 patients whose illness had been stabilized. This protocol used a long-acting insulin analog (glargine) and a rapid-acting insulin analog (aspart). Doses were titrated according to blood-glucose levels, which were measured at least four times a day. In patients treated with subcutaneous insulin, the mean capillary blood glucose concentration was 145.6 mg/ml. Of 18,067 blood glucose measurements, 58.6% were in the target range for this protocol (80–150 mg/dl) and 74.3% were in the clinically acceptable range (80–180 mg/dl). Hypoglycemia and hyperglycemia were recorded in 1.3% and 0.4% of these measurements, respectively.

The authors conclude that both of these protocols provide safe, efficient and cost-effective glycemic control for hospitalized patients, while reducing their risk of hypoglycemia.