Hyperglycemia in acutely ill patients.

MOST PHYSICIANS WILL ENcounter acutely ill patients who develop hyperglycemia. A third of all persons admitted to an urban general hospital had fasting glucose levels exceeding 126 mg/dL (7 mmol/L), or 2 or more random glucose levels exceeding 200 mg/dL (11.1 mmol/L); a third of those patients with hyperglycemia did not have a prior diagnosis of diabetes. Physicians often perceive hyperglycemia as a consequence of stress that runs parallel to the clinical course of an acute illness. Clinicians often start treatment of hyperglycemia only after glucose levels have exceeded 200 to 250 mg/dL (11-14 mmol/L). One reason for this is the perception that avoidance of hypoglycemia and its potential consequences is more important than glycemic control while patients are hospitalized. We discuss the evidence supporting the hyperglycemic milieu as a risk factor for adverse outcomes in the acutely ill patient with and without known diabetes, and we focus on the efficacy and safety of implementing tighter glycemic control for hospitalized patients.