Does glycemic status at admission predict mortality in noncritically ill hospitalized patients?

Abstract

Hyperglycemic patients hospitalized as a result of acute medical conditions are prone to increased morbidity and mortality. In this Practice Point commentary, we discuss a study by Baker et al., which suggests that newly detected hyperglycemia is an important predictor of mortality in this patient group. In addition, an HbA_1c level of >6% identified patients at the highest risk of death. Efforts to control glycemia should, therefore, be focused on this group. Unfortunately, optimal targets and treatment strategies for glycemic control in noncritically ill patients have not yet been determined. Tight glycemic control is associated with a potential risk of hypoglycemia; however, glucose levels within the normal range might result in improved outcomes. Furthermore, several studies suggest a direct beneficial effect of insulin therapy. Although the evidence is incomplete, it seems prudent to initiate insulin treatment whenever hyperglycemia is recognized in a hospitalized patient.