Call to action on glycemic control

March 2006
Feature Story

Anne Paxton

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 patients.
• 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 settings.
• 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 safety.
• 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 or www.diabetes.org.

Related Links

• A controlling interest in ICU blood sugars
• Nearing high tide on low blood sugars