American Association of Clinical Endocrinology Recommendations for Inpatient Glycemic Control

I. Critically Ill Patients
• Insulin therapy should be initiated for treatment of
persistent hyperglycemia, starting at a threshold of no
greater than 180 mg/dL (10.0 mmol/L).
• Once insulin therapy has been started, a glucose range
of 140 to 180 mg/dL (7.8 to 10.0 mmol/L) is recommended
for the majority of critically ill patients.
• Intravenous insulin infusions are the preferred method
for achieving and maintaining glycemic control in
critically ill patients.
• Validated insulin infusion protocols with demonstrated
safety and efficacy, and with low rates of occurrence
of hypoglycemia, are recommended.
• With IV insulin therapy, frequent glucose monitoring
is essential to minimize the occurrence of hypoglycemia
and to achieve optimal glucose control.

II. Noncritically Ill Patients
• For the majority of noncritically ill patients treated
with insulin, the premeal BG target should generally
be <140 mg/dL (<7.8 mmol/L) in conjunction with
random BG values <180 mg/dL (<10.0 mmol/L), provided
these targets can be safely achieved.
• More stringent targets may be appropriate in stable
patients with previous tight glycemic control.
• Less stringent targets may be appropriate in terminally
ill patients or in patients with severe comorbidities.
• Scheduled subcutaneous administration of insulin,
with basal, nutritional, and correction components, is
the preferred method for achieving and maintaining
glucose control.
• Prolonged therapy with SSI as the sole regimen is
discouraged.
• Noninsulin antihyperglycemic agents are not appropriate
in most hospitalized patients who require therapy
for hyperglycemia.
• Clinical judgment and ongoing assessment of clinical
status must be incorporated into day-to-day decisions
regarding treatment of hyperglycemia.

III. Safety Issues
• Overtreatment and undertreatment of hyperglycemia
represent major safety concerns.
• Education of hospital personnel is essential in engaging
the support of those involved in the care of inpatients
with hyperglycemia.
• Caution is required in interpreting results of POC glucose
meters in patients with anemia, polycythemia,
hypoperfusion, or use of some medications.
• Buy-in and financial support from hospital administration
are required for promoting a rational systems
approach to inpatient glycemic management.

IV. Cost
• Appropriate inpatient management of hyperglycemia
is cost-effective.

V. Discharge Planning
• Preparation for transition to the outpatient setting
should begin at the time of hospital admission.
• Discharge planning, patient education, and clear communication
with outpatient providers are critical for
ensuring a safe and successful transition to outpatient
glycemic management.

VI. Needed Research
• A selected number of research questions and topics for
guiding the management of inpatient hyperglycemia
in various hospital settings are proposed.