title: Glycemic control in non-critically ill hospitalized patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  The effect of intensive therapy to achieve tight glycemic control in patients hospitalized in non-critical care settings is unclear.
  
  
  METHODS
  We conducted a systematic review and meta-analysis to determine the effect of intensive glycemic control strategies on the outcomes of death, stroke, myocardial infarction, incidence of infection, and hypoglycemia. We included randomized and observational studies. Bibliographic databases were searched through February 2010. Random effects model was used to pool results across studies.
  
  
  RESULTS
  Nineteen studies (nine randomized and 10 observational studies) were included. The risk of bias across studies was moderate. Meta-analysis demonstrates that intensive glycemic control was not associated with significant effect on the risk of death, myocardial infarction, or stroke. There was a trend for increased risk of hypoglycemia (relative risk, 1.58; 95% confidence interval, 0.97-2.57), particularly in surgical studies and when the planned glycemic target was achieved. Intensive glycemic control was associated with decreased risk of infection (relative risk, 0.41; 95% confidence interval, 0.21-0.77) that was mainly derived from studies in surgical settings.
  
  
  CONCLUSIONS
  Intensive control of hyperglycemia in patients hospitalized in non-critical care settings may reduce the risk of infection. The quality of evidence is low and mainly driven by studies in surgical settings.
authors.affiliation: The Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. Murad.mohammad@mayo.edu
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
authors.forename: John A
authors.initials: JA
authors.lastname: Coburn
authors.forename: Fernando
authors.initials: F
authors.lastname: Coto-Yglesias
authors.forename: Svitlana
authors.initials: S
authors.lastname: Dzyubak
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hazem
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Lane
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism*; D016638:Critical Illness; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000378:metabolism / Q000517:prevention & control; D007003:Hypoglycemia / Q000378:metabolism / Q000517:prevention & control; D007297:Inpatients; D012107:Research Design
chemical_list: D001786:Blood Glucose