ACP: Decrease use of intensive insulin therapy in hospitalized patients

May 28, 2013

a new, evidence-based paper by the American College of Physicians Clinical Guidelines Committee suggests intensive insulin therapy does not show a consistent benefit and may lead to harm.

Intensive insulin therapy (IIT) is commonly used to control hyperglycemia in hospitalized patients. But a new, evidence-based paper by the American College of Physicians’ (ACP) Clinical Guidelines Committee suggests IIT does not show a consistent benefit and may lead to harm.

The paper, published in the American Journal of Medical Quality, said IIT consumes more resources and is more expensive than managing hyperglycemia with standard therapy.

“Clinicians caring for hospitalized patients must keep the harms of hypoglycemia in mind when managing hypoglycemia and should avoid aggressive glucose management,” said Amir Qaseem, MD, PhD, MHA, FACP, director, clinical policy, ACP. “[IIT] should not be used to strictly control blood glucose or to normalize blood glucose in [surgical or medical intensive care unit patients] with or without diabetes.”

The ACP review found that using IIT to achieve strict glucose control, compared to standard therapy with less strict control, did not reduce mortality or length of hospital stay, and increased the risk of severe hypoglycemia.

ACP recommends a blood glucose target level of 140 to 200 mg/dl for IIT use, and avoiding targets less than 140 mg/dl.