Devan Kansagara, MD, MCR; Paul Shekelle, MD, PhD; Amir Qaseem, MD, PhD, MHA
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2725.
Kansagara D., Shekelle P., Qaseem A.; Intensive Insulin Therapy in Hospitalized Patients. Ann Intern Med. 2011;154:847-848. doi: 10.7326/0003-4819-154-12-201106210-00022
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Published: Ann Intern Med. 2011;154(12):847-848.
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 threshold, such as 6.1 mmol/L (110 mg/dL), primarily in very ill, hospitalized patients receiving parenteral nutrition. This guideline should be interpreted to mean that diabetic patients receiving insulin therapy should use their normal dosage of insulin while they are hospitalized; for example, the use of preprandial insulin should be based on the preprandial blood glucose level.
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