New guidance from the American College of Physicians for glycemic control in hospitalized patients discourages the use of intensive insulin therapy (IIT). The guidelines are based on a systematic review that concluded that no consistent evidence demonstrates IIT targeted to strict glycemic control compared with less strict glycemic control improves health outcomes in hospitalized patients.
Data supporting the new guideline, drawn from 21 trials in intensive care units, perioperative care, myocardial infarction, and stroke or brain injury settings, found that IIT did not improve short-term mortality, long-term mortality, infection rates, length of stay, or the need for renal replacement therapy. In addition, IIT was associated with a 6-fold increase in risk for severe hypoglycemia in all hospital settings.
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