Defining the benefits of euglycemia in the hospitalized patient

Until recently it had been argued that hospitalization was not the time in the life of a patient to insist on tight glycemic control. Hyperglycemia was understood to be a consequence of medical stress. It was well known that infection, sepsis, or other medical stress might exacerbate hyperglycemia or promote a diabetic crisis. Admittedly, the severity of hyperglycemia among patients who have diabetes was thought to predict the risk for hospitalization with infection as well as the outcome of the infectious condition. – 8 However, until recently strict glycemic control in the hospital was not strongly advocated because hypoglycemia might occur and might be directly and uniquely traceable to actions taken in the hospital. Furthermore, the complications of diabetes were thought to be divided into acute metabolic emergencies and chronic tissue complications such as polyneuropathy, retinopathy, nephropathy, and macrovascular disease that would have evolved over a period longer than the duration of hospitalization, and the possibility that short-term hyperglycemia might affect outcomes was considered unproven. The purpose of this article is to define the specific populations, disorders, and hospital settings for which there now is strong evidence that short-term glycemic control will affect the outcome of a course of hospital treatment.