Intensive Insulin Therapy in Hospitalized Patients

TO THE EDITOR: I appreciated Qaseem and colleagues’ extensive review of in-hospital glucose targets (1). Perhaps I misunderstood, but I think that the stated target blood glucose level of 7.8 to 11.1 mmol/L (140 to 200 mg/dL) includes all patients. When I looked at the references, however, most of them seemed to discuss patients who are receiving nothing by mouth because they are critically ill, are postoperative, or have had recent neurologic events. Most of the time, if a hospitalized patient is eating, we in the medical community almost universally check the preprandial capillary glucose level. If it is 11.1 mmol/L (200 mg/dL), the postprandial blood glucose level would be higher and outside of the target range. I did not interpret Qaseem and colleagues’ article as suggesting that mealtime insulin coverage is not needed if the preprandial blood glucose level is less than 11.1 mmol/L ( 200 mg/dL). This is the interpretation of many of my colleagues. My understanding is that they are recommending that all blood glucose levels, both preprandial and postprandial, be less than 11.1 mmol/L ( 200 mg/dL); please clarify this recommendation.