Intensive Insulin Therapy in Hospitalized Patients
Authors: Devan Kansagara, Paul Shekelle, Amir Qaseem
Journal: Annals of Internal Medicine (2011)

Letters21 June 2011Intensive Insulin Therapy in Hospitalized PatientsDevan Kansagara, MD, MCR, Paul Shekelle, MD, PhD, and Amir Qaseem, MD, PhD, MHADevan Kansagara, MD, MCRFrom Portland Veterans Affairs Medical Center, Portland, OR 97239; West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073; and American College of Physicians, Philadelphia, PA 19106.Search for more papers by this author, Paul Shekelle, MD, PhDFrom Portland Veterans Affairs Medical Center, Portland, OR 97239; West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073; and American College of Physicians, Philadelphia, PA 19106.Search for more papers by this author, and Amir Qaseem, MD, PhD, MHAFrom Portland Veterans Affairs Medical Center, Portland, OR 97239; West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073; and American College of Physicians, Philadelphia, PA 19106.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-12-201106210-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We thank Dr. Bentson, Dr. Furnary, Dr. Garg, and Dr. Korytkowski and colleagues for their comments on the ACP clinical guideline on inpatient glycemic control.Dr. Bentson assumed that our guideline should not be interpreted to mean that patients on oral diets should not receive insulin therapy if their preprandial blood glucose level is less than 11.1 mmol/L (<200 mg/dL). She is correct. Although this population of hospitalized patients has not been specifically studied in terms of target thresholds of blood glucose levels, our guideline discussed the use of IIT to maintain blood glucose levels below a low ...References1. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359-67. [PMID: 11794168] CrossrefMedlineGoogle Scholar2. Vanhorebeek I, Ingels C, Van den Berghe G. Intensive insulin therapy in high-risk cardiac surgery patients: evidence from the Leuven randomized study. Semin Thorac Cardiovasc Surg. 2006;18:309-16. [PMID: 17395027] CrossrefMedlineGoogle Scholar3. Kansagara D, Fu R, Freeman M, Wolf F, Helfand M. Intensive insulin therapy in hospitalized patients: a systematic review. Ann Intern Med. 2011;154:268-82. [PMID: 21320942] LinkGoogle Scholar4. Kirdemir P, Yildirim V, Kiris I, Gulmen S, Kuralay E, Ibrisim E, et al. Does continuous insulin therapy reduce postoperative supraventricular tachycardia incidence after coronary artery bypass operations in diabetic patients? J Cardiothorac Vasc Anesth. 2008;22:383-7. [PMID: 18503925] CrossrefMedlineGoogle Scholar5. Smith A, Grattan A, Harper M, Royston D, Riedel BJ. Coronary revascularization: a procedure in transition from on-pump to off-pump? The role of glucose-insulin-potassium revisited in a randomized, placebo-controlled study. J Cardiothorac Vasc Anesth. 2002;16:413-20. [PMID: 12154417] CrossrefMedlineGoogle Scholar6. Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, et al; NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283-97. [PMID: 19318384] CrossrefMedlineGoogle Scholar7. Furnary AP, Wu Y, Bookin SO. Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project. Endocr Pract. 2004;10 Suppl 2 21-33. [PMID: 15251637] CrossrefMedlineGoogle Scholar8. Umpierrez GE, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care. 2011;34:256-61. [PMID: 21228246] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Portland Veterans Affairs Medical Center, Portland, OR 97239; West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073; and American College of Physicians, Philadelphia, PA 19106.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2725. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoUse of Intensive Insulin Therapy for the Management of Glycemic Control in Hospitalized Patients: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Linda L. Humphrey , Roger Chou , Vincenza Snow , Paul Shekelle , and Intensive Insulin Therapy in Hospitalized Patients: A Systematic Review Devan Kansagara , Rongwei Fu , Michele Freeman , Fawn Wolf , and Mark Helfand Intensive Insulin Therapy in Hospitalized Patients Lynn Bentson Intensive Insulin Therapy in Hospitalized Patients Anthony P. Furnary Intensive Insulin Therapy in Hospitalized Patients Rajesh Garg Intensive Insulin Therapy in Hospitalized Patients Mary Korytkowski , Etie Moghissi , and Guillermo Umpierrez Metrics 21 June 2011Volume 154, Issue 12Page: 847-848KeywordsBloodCardiac surgeryGlucoseInpatientsInsulinIntensive care unitsSepsisSurvival analysisType 2 diabetes ePublished: 21 June 2011 Issue Published: 21 June 2011 CopyrightCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...