Inpatient insulin therapy.
OBJECTIVE
In a 2001 report from a surgical intensive care unit in Leuven, Belgium, intravenous insulin infusion targeting blood glucose 80-110 mg/dl reduced patient mortality and morbidities. Subsequent research has failed to define glycemic targets necessary or sufficient for attainment of desired health outcomes in other inpatient settings, but a large body of evidence suggests hospital outcomes are related to hyperglycemia.


RESULTS
Recent literature describes observational evidence for hypoglycemia as an independent predictor of mortality in a general medical intensive care unit; superiority of performance of computerized intravenous insulin algorithms in comparison to earlier manual algorithms; acceptability of early transition to scheduled basal prandial correction subcutaneous insulin analog therapy for maintenance of glycemic targets after induction of euglycemia by intravenous insulin infusion, among cardiothoracic surgery patients; inferiority of sliding scale insulin compared to basal prandial correction therapy; and feasibility of diabetes patient self-management in the hospital setting.


CONCLUSIONS
With development of improved insulin administration strategies problems of hypoglycemia and variability of glycemic control are reduced. Investigators and care providers need to achieve glycemic targets to optimize patient outcomes.
Braithwaite
Susan Shapiro
SS
Division of Endocrinology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27599-7172, USA. sbraithw@med.unc.edu
D000465:Algorithms; D001530:Belgium; D001786:Blood Glucose / Q000378:metabolism; D004750:Enteral Nutrition; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D007362:Intensive Care Units; D016032:Randomized Controlled Trials as Topic
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin