Clinical Evidence for Glucose Control in the Inpatient Setting

Key Points

  • Epidemiologic studies show that glucose control in hospitals is woefully inadequate.

    • Approximately 30% of hospitalized patients have blood glucose values >180 mg/dL.

      • As glucose levels rise, so does mortality risk, as well as the risk of dehydration, hypotension, eventual renal shutdown, poor healing, and impaired immune system function.

    • Another 6% to 7% of patients have glucose values in the hypoglycemic range (<70 mg/dL) and are at risk for neuroglycopenia, brain dysfunction, and cardiac arrhythmias, which can prove fatal in vulnerable populations.

  • Although definitive data on optimal glucose targets for hospitalized patients are lacking due to a small number of trials, some conclusions can be drawn:

    • Good glucose control (blood glucose 140-180 mg/dL) is likely to be sufficient to improve clinical outcomes in the critical care setting, while near-normal control (blood glucose <110 mg/dL) increases risks for most inpatients in most hospitals.

    • Hyperglycemia and hypoglycemia are markers of poor outcomes in critically ill and noncritically ill patients.

    • Recent studies do not endorse a casual approach to inpatient glucose control.

  • Consensus guidelines have been issued by the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) for all hospitalized patients and separately by The Endocrine Society (TES) for noncritically ill patients.

    • Blood glucose targets for critically ill inpatients (AACE/ADA)

      • Treatment threshold: >180 mg/dL

      • Goal <140-180 mg/dL for most patients

      • Lower threshold of 110 mg/dL for selected, low-risk patients

      • Hypoglycemia defined as <70 mg/dL or <100 mg/dL (TES)

    • Blood glucose targets for noncritically ill inpatients (AACE/ADA and TES)

      • Treatment threshold: >180 mg/dL

      • Goal <140 mg/dL for most patients

      • Hypoglycemia defined as <70 mg/dL (AACE/ADA) or

  • AACE, ADA, and TES all strongly discourage use of sliding scale insulin, which has been shown to lead to undesirable levels of both hypoglycemia and hyperglycemia relative to basal-bolus insulin approaches.

Suggested Reading

Clinical Guidelines


Deedwania P, Kosiborod M, Barrett E; American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism. Hyperglycemia and acute coronary syndrome: a scientific statement from the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2008;117:1610-1619.

Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009;15:353-69.

Qaseem A, Humphrey LL, Chou R, Snow V, Shekelle P. Use of intensive insulin therapy for the management of glycemic control in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2011;154:260-267.

Society of Hospital Medicine. The case for supporting inpatient glycemic control programs now: the evidence and beyond. 2008.

Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012;97:16-38.

Key Prospective Studies, Reviews, and Meta-analyses


Bailon RM, Partlow BJ, Miller-Cage V, et al. Continuous subcutaneous insulin infusion (insulin pump) therapy can be safely used in the hospital in select patients. Endocr Pract. 2009;15:24-29.

Bernard JB, Munoz C, Harper J, Muriello M, Rico E, Baldwin D. Treatment of inpatient hyperglycemia beginning in the emergency department: a randomized trial using insulins aspart and detemir compared with usual care. J Hosp Med. 2011;6:279-284.

Finfer S, Heritier S. The NICE-SUGAR (Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation) Study: statistical analysis plan. Crit Care Resusc. 2009;11:46-57.

Griesdale DE, de Souza RJ, van Dam RM, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ. 2009;180:821-827.

Hirsch IB. Inpatient diabetes: review of data from the cardiac care unit. Endocr Pract. 2006;12(suppl 3):27-34.

Kansagara D, Fu R, Freeman M, Wolf F, Helfand M. Intensive insulin therapy in hospitalized patients: a systematic review. Ann Intern Med. 2011;154:268-282.

McDonnell ME, Umpierrez GE. Insulin therapy for the management of hyperglycemia in hospitalized patients. Endocrinol Metab Clin North Am. 2012;41:175-201.

Moghissi ES. Reexamining the evidence for inpatient glucose control: new recommendations for glycemic targets. Am J Health Syst Pharm. 2010;67(16 Suppl 8):S3-S8.

NICE-SUGAR Study Investigators. Hypoglycemia and risk of death in critically ill patients. N Engl J Med. 2012;367:1108-1118.

NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283-1297.

Pittas AG, Siegel RD, Lau J. Insulin therapy and in-hospital mortality in critically ill patients: systematic review and meta-analysis of randomized controlled trials. J Parenter Enteral Nutr. 2006;30:164-172.

Queale WS, Seidler AJ, Brancati FL. Glycemic control and sliding scale insulin use in medical inpatients with diabetes mellitus. Arch Intern Med. 1997;157:545-552.

Umpierrez GE, Hor T, Smiley D, et al. Comparison of inpatient insulin regimens with detemir plus aspart versus neutral protamine hagedorn plus regular in medical patients with type 2 diabetes. J Clin Endocrinol Metab. 2009;94:564-569.

Umpierrez GE, Smiley D, Zisman A, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care. 2007;30:2181-2186.

Umpierrez GE. Basal versus sliding-scale regular insulin in hospitalized patients with hyperglycemia during enteral nutrition therapy. Diabetes Care. 2009;32:751-753.

Umpierrez GE, Smiley D, Jacobs S, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care. 2011;34:256-261.

Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354:449-461.

Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359-1367.

Vlasselaers D, Milants I, Desmet L, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. 2009;373:547-556.

Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA. 2008;300:933-944.

Prevalence Data


Arinzon Z, Shabat S, Shuval I, et al. Prevalence of diabetes mellitus in elderly patients received enteral nutrition long-term care service. Arch Gerontol Geriatr. 2008;47:383-393.

Bartnik M, Ryden L, Ferrari R, et al. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart. Eur Heart J. 2004;25:1880-1890.

Boord JB, Greevy RA, Braithwaite SS, et al. Evaluation of hospital glycemic control at US academic medical centers. J Hosp Med. 2009;4:35-44.

Conaway DG, O'Keefe JH, Reid KJ, et al. Frequency of undiagnosed diabetes mellitus in patients with acute coronary syndrome. Am J Cardiol. 2005;96:363-365.

Palacio A, Smiley D, Ceron M, et al. Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital. J Hosp Med. 2008;3:212-217.

Swanson CM, Potter DJ, Kongable GL, Cook CB. Update on inpatient glycemic control in hospitals in the United States. Endocr Pract. 2011;17:853-861.

Wexler DJ, Meigs JB, Cagliero E, Nathan DM, Grant RW. Prevalence of hyper- and hypoglycemia among inpatients with diabetes: a national survey of 44 U.S. hospitals. Diabetes Care. 2007;30:367-369.

Additional Reading


Ainla T, Baburin A, Teesalu R, et al. The association between hyperglycaemia on admission and 180-day mortality in acute myocardial infarction patients with and without diabetes. Diabet Med. 2005;22:1321-1325.

Amori RE, Pittas AG, Siegel RD, et al. Inpatient medical errors involving glucose-lowering medications and their impact on patients: review of 2,598 incidents from a voluntary electronic error-reporting database. Endocr Pract. 2008;14:535-542.

Anthony M. Treatment of hypoglycemia in hospitalized adults: a descriptive study. Diabetes Educ. 2007;33:709-715.

Asudani D, Calles-Escandon J. Inpatient hyperglycemia: slide through the scale but cover the bases first. J Hosp Med. 2007;2(suppl 1):23-32.

Baker EH, Janaway CH, Philips BJ, et al. Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. Thorax. 2006;61:284-289.

Baldwin D, Villanueva G, McNutt R, et al. Eliminating inpatient sliding-scale insulin: a reeducation project with medical house staff. Diabetes Care. 2005;28:1008-1011.

Bates D, Clark NG, Cook RI, et al. American College of Endocrinology and American Association of Clinical Endocrinologists position statement on patient safety and medical system errors in diabetes and endocrinology. Endocr Pract. 2005;11:197-202.

Beardsall K, Vanhaesebrouck S, Ogilvy-Stuart AL, et al. Early insulin therapy in very-low-birth-weight infants. N Engl J Med. 2008;359:1873-1884.

Becker T, Moldoveanu A, Cukierman T, et al. Clinical outcomes associated with the use of subcutaneous insulin-by-glucose sliding scales to manage hyperglycemia in hospitalized patients with pneumonia. Diabetes Res Clin Pract. 2007;78:392-397.

Bhattacharyya A, Christodoulides C, Kaushal K, et al. In-patient management of diabetes mellitus and patient satisfaction. Diabet Med. 2002;19:412-416.

Bochicchio GV, Joshi M, Bochicchio KM, et al. Early hyperglycemic control is important in critically injured trauma patients. J Trauma. 2007;63:1353-1358.

Bochicchio GV, Sung J, Joshi M, et al. Persistent hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma. 2005;58:921-924.

Bolk J, van der Ploeg T, Cornel JH, et al. Impaired glucose metabolism predicts mortality after a myocardial infarction. Int J Cardiol. 2001;79:207-214.

Braithwaite SS, Buie MM, Thompson CL, et al. Hospital hypoglycemia: not only treatment but also prevention. Endocr Pract. 2004;10(suppl 2):89-99.

Branco RG, Garcia PC, Piva JP, et al. Glucose level and risk of mortality in pediatric septic shock. Pediatr Crit Care Med. 2005;6:470-472.

Brunkhorst FM, Engel C, Bloos F, for the German Competence Network Sepsis (SepNet). Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125-139.

Bruno A, Gregorio D, Caropreso A. Normal glucose values are associated with a lower risk of mortality in hospitalized patients. Diabetes Care. 2008;31:2209-2210.

Capes SE, Hunt D, Malmberg K, et al. Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. 2000;355:773-778.

Capes SE, Hunt D, Malmberg K, et al. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001;32:2426-2432.

Cheung NW, Napier B, Zaccaria C, et al. Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition. Diabetes Care. 2005;28:2367-2371.

Cheung NW, Wong VW, McLean M. The Hyperglycemia: Intensive Insulin Infusion in Infarction (HI-5) study: a randomized controlled trial of insulin infusion therapy for myocardial infarction. Diabetes Care. 2006;29:765-770.

Clement S. Better glycemic control in the hospital: beneficial and feasible. Cleve Clin J Med. 2007;74:111-2, 114-20.

Cochran A, Davis L, Morris SE, et al. Safety and efficacy of an intensive insulin protocol in a burn-trauma intensive care unit. J Burn Care Res. 2008;29:187-191.

Cohen LS, Sedhom L, Salifu M, et al. Inpatient diabetes management: examining morning practice in an acute care setting. Diabetes Educ. 2007;33:483-492.

Collier B, Diaz J Jr, Forbes R, et al. The impact of a normoglycemic management protocol on clinical outcomes in the trauma intensive care unit. J Parenter Enteral Nutr. 2005;29:353-358.

Cook CB, Castro JC, Schmidt RE, et al. Diabetes care in hospitalized noncritically ill patients: More evidence for clinical inertia and negative therapeutic momentum. J Hosp Med. 2007;2:203-211.

Cook CB, Jameson KA, Hartsell ZC, et al. Beliefs about hospital diabetes and perceived barriers to glucose management among inpatient midlevel practitioners. Diabetes Educ. 2008;34:75-83.

Cook CB, McNaughton DA, Braddy CM, et al. Management of inpatient hyperglycemia: assessing perceptions and barriers to care among resident physicians. Endocr Pract. 2007;13:117-124.

Cook CB, Moghissi E, Joshi R, et al. Inpatient point-of-care bedside glucose testing: preliminary data on use of connectivity informatics to measure hospital glycemic control. Diabetes Technol Ther. 2007;9:493-500.

Cook CB, Stockton L, Baird M, et al. Working to improve care of hospital hyperglycemia through statewide collaboration: the Georgia Hospital Association Diabetes Special Interest Group. Endocr Pract. 2007;13:45-50.

Cook CB, Wellik KE, Kongable GL, Shu J. Assessing inpatient glycemic control: what are the next steps? J Diabetes Sci Technol. 2012;6:421-427.

Cook CB. Use of continuous subcutaneous insulin infusion (insulin pump) therapy in the hospital setting: proposed guidelines and outcomes measures. Diabetes Educ. 2005;31:849-857.

CREATE-ECLA Trial Group Investigators. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction. JAMA. 2005;293:437-446.

Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care. 2003;26:1902-1912.

Cryer PE. Diverse causes of hypoglycemia-associated autonomic failure in diabetes. N Engl J Med. 2004;350:2272-2279.

Cryer PE. Hypoglycaemia: the limiting factor in the glycaemic management of the critically ill? Diabetologia. 2006;49:1722-1725.

D'Orazio P, Burnett RW, Fogh-Andersen N; International Federation of Clinical Chemistry Scientific Division Working Group on Selective Electrodes and Point of Care Testing. Approved IFCC recommendation on reporting results for blood glucose (abbreviated). Clin Chem. 2005;51:1573-1576.

Davidson JA, Wilkinson A; International Expert Panel on New-Onset Diabetes after Transplantation. New-Onset Diabetes After Transplantation 2003 International Consensus Guidelines: an endocrinologist's view. Diabetes Care. 2004;27:805-812.

De La Rosa GC, Donado JH, Restrepo AH, et al; GICI-HPTU. Strict glycaemic control in patients hospitalised in a mixed medical and surgical intensive care unit: a randomised clinical trial. Crit Care. 2008,12:R120.

Derr RL, Hsiao VC, Saudek CD. Antecedent hyperglycemia is associated with an increased risk of neutropenic infections during bone marrow transplantation. Diabetes Care. 2008;31:1972-1977.

DeSantis AJ, Schmeltz LR, Schmidt K, et al. Inpatient management of hyperglycemia: the Northwestern experience. Endocr Pract. 2006;12:491-505.

Donihi AC, Raval D, Saul M, et al. Prevalence and predictors of corticosteroid-related hyperglycemia in hospitalized patients. Endocr Pract. 2006;12:358-362.

Duane TM, Ivatury RR, Dechert T, et al. Blood glucose levels at 24 hours after trauma fails to predict outcomes. J Trauma. 2008;64:1184-1187.

Egi M, Bellomo R, Stachowski E, et al. Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology. 2006;105:244-252.

Elinav H, Wolf Z, Szalat A, et al. In-hospital treatment of hyperglycemia: effects of intensified subcutaneous insulin treatment. Curr Med Res Opin. 2007;23:757-765.

Estrada CA, Young JA, Nifong LW, et al. Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting. Ann Thorac Surg. 2003;75:1392-1399.

Falcao G, Ulate K, Kouzekanani K, et al. Impact of postoperative hyperglycemia following surgical repair of congenital cardiac defects. Pediatr Cardiol. 2008;29:628-636.

Faustino EV, Apkon M. Persistent hyperglycemia in critically ill children. J Pediatr. 2005;146:30-34.

Finfer S, Delaney A. Tight glycemic control in critically ill adults. JAMA. 2008;300:963-965.

Finney SJ, Zekveld C, Elia A, et al. Glucose control and mortality in critically ill patients. JAMA. 2003;290:2041-2047.

Fonseca V. Newly diagnosed diabetes/hyperglycemia in hospitals: what should we do? Endocr Pract. 2006;12(suppl 3):108-111.

Forster AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161-167.

Frontera JA, Fernandez A, Claassen J, et al. Hyperglycemia after SAH: predictors, associated complications, and impact on outcome. Stroke. 2006;37:199-203.

Fuji S, Kim SW, Mori S, et al. Hyperglycemia during the neutropenic period is associated with a poor outcome in patients undergoing myeloablative allogeneic hematopoietic stem cell transplantation. Transplantation. 2007;84:814-820.

Furnary AP, Gao G, Grunkemeier GL, et al. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125:1007-1021.

Furnary AP, Wu Y, Bookin SO. Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project. Endocr Pract. 2004;10:21-33.

Furnary AP, Wu Y. Clinical effects of hyperglycemia in the cardiac surgery population: the Portland Diabetic Project. Endocr Pract. 2006;12(suppl 3):22-26.

Furnary AP, Zerr KJ, Grunkemeier GL, et al. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg. 1999;67:352-360.

Gale SC, Sicoutris C, Reilly PM, et al. Poor glycemic control is associated with increased mortality in critically ill trauma patients. Am Surg. 2007;73:454-460.

Gandhi GY, Nuttall GA, Abel MD, et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial. Ann Intern Med. 2007;146:233-243.

Garber AJ, Seidel J, Armbruster M. Current standards of care for inpatient glycemic management and metabolic control: is it time for definite standards and targets? Endocr Pract. 2004;10(suppl 2):10-12.

Garg R, Bhutani H, Jarry A, et al. Provider response to insulin-induced hypoglycemia in hospitalized patients. J Hosp Med. 2007;2:258-260.

Goldberg PA, Bozzo JE, Mesmer M, et al. “Glucometrics”—assessing the quality of inpatient glucose management. Diab Technol Therap. 2006;8:560-569.

Goldberg PA, Siegel MD, Russell RR, et al. Experience with the continuous glucose monitoring system in a medical intensive care unit. Diabetes Technol Ther. 2004;6:339-347.

Goldberg PA, Siegel MD, Sherwin RS, et al. Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. Diabetes Care. 2004;27:461-467.

Golden S, Peart-Vigilance C, Kao W, et al. Perioperative glycemic control and risk of infectious complications in a cohort of adults with diabetes. Diabetes Care. 1999;22:1408-1414.

Goyal A, Mahaffey KW, Garg J, et al. Prognostic significance of the change in glucose level in the first 24 h after acute myocardial infarction: results from the CARDINAL study. Eur Heart J. 2006;27:1289-1297.

Green Conaway DL, Enriquez JR, Barberena JE, et al. Assessment of and physician response to glycemic control in diabetic patients presenting with an acute coronary syndrome. Am Heart J. 2006;152:1022-1027.

Grey NJ, Perdrizet GA. Reduction of nosocomial infections in the surgical intensive-care unit by strict glycemic control. Endocr Pract. 2004;10(suppl 2):46-52.

Hammer MJ, Casper C, Gooley TA, et al. The contribution of malglycemia to mortality among allogeneic hematopoietic cell transplant recipients. Biol Blood Marrow Transplant. 2009;15:344-351.

Hassan E. Hyperglycemia management in the hospital setting. Am J Health Syst Pharm. 2007;64(10 suppl 6):S9-S14.

Held C, Gerstein HC, Yusuf S; ONTARGET/TRANSCEND Investigators. Glucose levels predict hospitalization for congestive heart failure in patients at high cardiovascular risk. Circulation. 2007;115:1371-1375.

Hellman R. A systems approach to reducing errors in insulin therapy in the inpatient setting. Endocr Pract. 2004;10(suppl 2):100-108.

Hellman R. Patient safety and inpatient glycemic control: translating concepts into action. Endocr Pract. 2006;12(suppl 3):49-55.

Hirsch IB. Effect of insulin therapy on nonglycemic variables during acute illness. Endocr Pract. 2004;10(suppl 2):63-70.

Hirsch IB. Sliding scale insulin—time to stop sliding. JAMA. 2009;301:213-214.

Hovorka R, Kremen J, Blaha J, et al. Blood glucose control by a model predictive control algorithm with variable sampling rate versus a routine glucose management protocol in cardiac surgery patients: a randomized controlled trial. J Clin Endocrinol Metab. 2007;92:2960-2964.

Inzucchi SE, Siegel MD. Glucose control in the ICU—how tight is too tight? N Engl J Med. 2009;360:1346-1349.

Ishihara M, Kojima S, Sakamoto T; Japanese Acute Coronary Syndrome Study Investigators. Acute hyperglycemia is associated with adverse outcome after acute myocardial infarction in the coronary intervention era. Am Heart J. 2005;150:814-820.

Jeremitsky E, Omert LA, Dunham CM, et al. The impact of hyperglycemia on patients with severe brain injury. J Trauma. 2005;58:47-50.

Kitabchi AE, Freire AX, Umpierrez GE. Evidence for strict inpatient blood glucose control: time to revise glycemic goals in hospitalized patients. Metabolism. 2008;57:116-120.

Klonoff DC. Intensive insulin therapy in critically ill hospitalized patients: making it safe and effective. J Diabetes Sci Technol. 2011;5:755-767.

Knecht LA, Gauthier SM, Castro JC, et al. Diabetes care in the hospital: is there clinical inertia? J Hosp Med. 2006;1:151-160.

Korytkowski MT, Salata RJ, Koerbel GL, et al. Insulin therapy and glycemic control in hospitalized patients with diabetes during enteral nutrition therapy. Diabetes Care. 2009;32:594–596.

Kosiborod M, Inzucchi SE, Goyal A, et al. Relationship between spontaneous and iatrogenic hypoglycemia and mortality in patients hospitalized with acute myocardial infarction. JAMA. 2009;301:1556-1564.

Kosiborod M, Inzucchi SE, Krumholz HM, et al. Glucometrics in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk. Circulation. 2008;117:1018-1027.

Kosiborod M, Rathore SS, Inzucchi S, et al. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation. 2005;111:3078-3086.

Krinsley JS, Grover A. Severe hypoglycemia in critically ill patients: risk factors and outcomes. Crit Care Med. 2007;35:2262-2267.

Krinsley JS, Jones RL. Cost analysis of intensive glycemic control in critically ill adult patients. Chest. 2006;129:644-650.

Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003;78:1471-1478.

Krinsley JS. Effect of intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc. 2004;79:992-1000.

Krinsley JS. Glycemic control, diabetic status, and mortality in a heterogeneous population of critically ill patients before and during the era of intensive glycemic management: six and one-half years experience at a university-affiliated community hospital. Semin Thorac Cardiovasc Surg. 2006;18:317-325.

Laird AM, Miller PR, Kilgo PD, et al. Relationship of early hyperglycemia to mortality in trauma patients. J Trauma. 2004;56:1058-62.

Lansang MC, Harrell H. Knowledge on inpatient diabetes among fourth-year medical students. Diabetes Care. 2007;30:1088-1091.

Latham R, Lancaster AD, Covington JF, et al. The association of diabetes and glucose control with surgical site infection among cardiothoracic surgery patients. Infec Control Hosp Epidemiol. 2001;22:607-612.

Lazar HL, Chipkin SR, Fitzgerald CA, et al. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation. 2004;109:1497-1502.

Levetan CS. Effect of hyperglycemia on stroke outcomes. Endocr Pract. 2004;10(suppl 2):34-39.

Lewis EF, Moye LA, Rouleau JL; CARE Study. Predictors of late development of heart failure in stable survivors of myocardial infarction: the CARE study. J Am Coll Cardiol. 2003;42:1446-1453.

Lukins MB, Manninen PH. Hyperglycemia in patients administered dexamethasone for craniotomy. Anesthesia & Analgesia. 2005;100:1129-1133.

Malmberg K, DIGAMI Study Group. Prospective randomised study of intensive insulin treatment on long-term survival after acute myocardial infarction in patients with diabetes mellitus. Br Med J. 1997;314:1512-1515.

Malmberg K, Norhammar A, Wedel H, et al. Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. Circulation. 1999;99:2626-2632.

Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol. 1995;26:57-65.

Malmberg K, Ryden L, Wedel H; DIGAMI 2 Investigators. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J. 2005;26:650-661.

Malmberg K, Ryden L. Myocardial infarction in patients with diabetes mellitus. Eur Heart J. 1988;9:259-264.

Malmberg K. Role of insulin-glucose infusion in outcomes after acute myocardial infarction: the diabetes and insulin-glucose infusion in acute myocardial infarction (DIGAMI) study. Endocr Pract. 2004;10(suppl 2):13-16.

Matheny ME, Shubina M, Kimmel ZM, et al. Treatment intensification and blood glucose control among hospitalized diabetic patients. J Gen Intern Med. 2008;23:184-189.

McAlister FA, Majumdar SR, Blitz S, et al. The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia. Diabetes Care. 2005;28:810-815.

Mehta SR, Yusuf S, Diaz R; CREATE-ECLA Trial Group Investigators. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: the CREATE-ECLA randomized controlled trial. JAMA. 2005;293:437-446.

Meynaar IA, Dawson L, Tangkau PL, et al. Introduction and evaluation of a computerised insulin protocol. Intensive Care Med. 2007;33:591-596.

Mills RD, Schwartz F, Shubrook JH. Evaluation of diabetes management in a rural community hospital. Endocr Pract. 2008;14:50-55.

Mitrakou A, Ryan C, Veneman T, et al. Hierarchy of glycemic thresholds for counterregulatory hormone secretion, symptoms, and cerebral dysfunction. Am J Physiol. 1991;260(1 Pt 1):E67-E74.

Mizock BA. Alterations in carbohydrate metabolism during stress: a review of the literature. Am J Med. 1995;98:75-84.

Moghissi E. Hospital management of diabetes: beyond the sliding scale. Cleve Clin J Med. 2004;71:801-808.

Moghissi ES, Hirsch IB. Hospital management of diabetes. Endocrinol Metab Clin North Am. 2005;34:99-116.

Moghissi ES. Insulin strategies for managing inpatient and outpatient hyperglycemia and diabetes. Mt Sinai J Med. 2008;75:558-566.

Montori VM, Bistrian BR, McMahon MM. Hyperglycemia in acutely ill patients. JAMA. 2002;288:2167-2169.

Mowery NT, Gunter OL, Guillamondegui O, et al. Stress insulin resistance is a marker for mortality in traumatic brain injury. J Trauma. 2009;66:145-151.

Mukamal KJ, Nesto RW, Cohen MC, et al. Impact of diabetes on long-term survival after acute myocardial infarction: comparability of risk with prior myocardial infarction. Diabetes Care. 2001;24:1422-1427.

Nazer LH, Chow SL, Moghissi ES. Insulin infusion protocols for critically ill patients: a highlight of differences and similarities. Endocr Pract. 2007;13:137-146.

Noordzij PG, Boersma E, Schreiner F, et al. Increased preoperative glucose levels are associated with perioperative mortality in patients undergoing noncardiac, nonvascular surgery. Eur J Endocrinol. 2007;156:137-142.

Norhammar A, Malmberg K, Diderholm E, et al. Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization. J Am Coll Cardiol. 2004;43:585-591.

Norhammar A, Malmberg K, Ryden L; Register of Information and Knowledge about Swedish Heart Intensive Care Admission (RIKS-HIA). Under utilisation of evidence-based treatment partially explains for the unfavourable prognosis in diabetic patients with acute myocardial infarction. Eur Heart J. 2003;24:838-844.

Norhammar A, Tenerz A, Nilsson G, et al. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet. 2002;359:2140-2144.

Norhammar AM, Ryden L, Malmberg K. Admission plasma glucose. Independent risk factor for long-term prognosis after myocardial infarction even in nondiabetic patients. Diabetes Care 1999;22:1827-1831.

Noschese M, Donihi AC, Koerbel G, et al. Effect of a diabetes order set on glycaemic management and control in the hospital. Qual Saf Health Care. 2008;17:464-468.

Nylen ES, Muller B. Endocrine changes in critical illness. J Intensive Care Med. 2004;19:67-82.

Pasternak JJ, McGregor DG, Schroeder DR; IHAST Investigators. Hyperglycemia in patients undergoing cerebral aneurysm surgery: its association with long-term gross neurologic and neuropsychological function. Mayo Clin Proc. 2008;83:406-417.

Pinto DS, Skolnick AH, Kirtane AJ, et al. U-shaped relationship of blood glucose with adverse outcomes among patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2005;46:178-180.

Pittas AG, Siegel RD, Lau J. Insulin therapy for critically ill hospitalized patients: a meta-analysis of randomized, control trials. Arch Inter Med. 2004;164:2005-2011.

Pomposelli JJ, Baxter JK 3rd, Babineau TJ, et al. Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. JPEN J Parenter Enteral Nutr. 1998;22:77-81.

Rady MY, Johnson DJ, Patel BM, et al. Influence of individual characteristics on outcome of glycemic control in intensive care unit patients with or without diabetes mellitus. Mayo Clin Proc. 2005;80:1558-1567.

Rea RS, Donihi AC, Bobeck M, et al. Implementing an intravenous insulin infusion protocol in the intensive care unit. Am J Health Syst Pharm. 2007;64:385-395.

Reed CC, Stewart RM, Sherman M, et al. Intensive insulin protocol improves glucose control and is associated with a reduction in intensive care unit mortality. J Am Coll Surg. 2007;204:1048-1054.

Reynolds LR, Cook AM, Lewis DA, et al. An institutional process to improve inpatient glycemic control. Qual Manag Health Care. 2007;16:239-249.

Rubin DJ, Moshang J, Jabbour SA. Diabetes knowledge: are resident physicians and nurses adequately prepared to manage diabetes? Endocr Pract. 2007;13:17-21.

Schmeltz LR, Desantis AJ, Schmidt K, et al. Conversion of intravenous insulin infusions to subcutaneously administered insulin glargine in patients with hyperglycemia. Endocr Pract. 2006;12:641-650.

Schnipper JL, Barsky EE, Shaykevich S, et al. Inpatient management of diabetes and hyperglycemia among general medicine patients at a large teaching hospital. J Hosp Med. 2006;1:145-150.

Scott MG, Bruns DE, Boyd JC, et al. Tight glucose control in the intensive care unit: are glucose meters up to the task? Clin Chem. 2009;55:18-20.

Shim YH, Kweon TD, Lee JH, et al. Intravenous glucose-insulin-potassium during off- pump coronary artery bypass surgery does not reduce myocardial injury. Acta Anaesthesiol Scand. 2006;50:954-961.

Shin S, Britt RC, Reed SF, et al. Early glucose normalization does not improve outcome in the critically ill trauma population. Am Surg. 2007;73:769-772.

Smith WD, Winterstein AG, Johns T, et al. Causes of hyperglycemia and hypoglycemia in adult inpatients. Am J Health Syst Pharm. 2005;62:714-719.

Sung J, Bochicchio GV, Joshi M, et al. Admission hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma. 2005;59:80-83.

Svensson AM, McGuire DK, Abrahamsson P, et al. Association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events. Eur Heart J. 2005;26:1255-1261.

Taylor BE, Schallom ME, Sona CS, et al. Efficacy and safety of an insulin infusion protocol in a surgical ICU. J Am Coll Surg. 2006;202:1-9.

Timmer JR, van der Horst IC, Ottervanger JP, et al. Prognostic value of admission glucose in non-diabetic patients with myocardial infarction. Am Heart J. 2004;148:399-404.

Treggiari MM, Karir V, Yanez ND, et al. Intensive insulin therapy and mortality in critically ill patients. Crit Care. 2008;12:R29.

Trence DL, Kelly JL, Hirsch IB. The rationale and management of hyperglycemia for in-patients with cardiovascular disease: time for change. J Clin Endocrinol Metab. 2003;88:2430-2437.

Trujillo JM, Barsky EE, Greenwood BC, et al. Improving glycemic control in medical inpatients: a pilot study. J Hosp Med. 2008;3:55-63.

Tuggle DW, Kuhn MA, Jones SK, et al. Hyperglycemia and infections in pediatric trauma patients. Am Surg. 2008;74:195-198.

Umpierrez G, Maynard G. Glycemic chaos (not glycemic control) still the rule for inpatient care: how do we stop the insanity? J Hosp Med. 2006;1:141-144.

Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87:978-982.

Umpierrez GE, Palacio A, Smiley D. Sliding scale insulin use: myth or insanity? Am J Med. 2007;120:563-567.

Umpierrez GE. Inpatient management of diabetes: an increasing challenge to the hospitalist physician. J Hosp Med. 2007;2(suppl 1):33-35.

Van den Berghe G, Schoonheydt K, Becx P, et al. Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology. 2005;64:1348-1353.

Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med. 2003;31:359-366.

Van den Berghe G, Wouters PJ, Kesteloot K, et al. Analysis of healthcare resource utilization with intensive insulin therapy in critically ill patients. Crit Care Med. 2006;34:612-616.

Van den Berghe GH. Role of intravenous insulin therapy in critically ill patients. Endocr Pract. 2004;10(suppl 2):17-20.

van der Crabben SN, Blümer RM, Stegenga ME, et al. Early endotoxemia increases peripheral and hepatic insulin sensitivity in healthy humans. J Clin Endocrinol Metab. 2009;94:463-468.

Vanhorebeek I, Langouche L, Van den Berghe G. Intensive insulin therapy in the intensive care unit: update on clinical impact and mechanisms of action. Endocr Pract. 2006;12(suppl 3):14-22.

Vogelzang M, van der Horst ICC, Nijsten MWN. Hyperglycemic index as a tool to assess glucose control: a retrospective study. Crit Care. 2004;8:R122-R127.

Wahab NN, Cowden EA, Pearce NJ; ICONS Investigators. Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era? J Am Coll Cardiol. 2002;40:1748-1754.

Wahl WL, Taddonio M, Maggio PM, et al. Mean glucose values predict trauma patient mortality. J Trauma. 2008;65:42-47.

Wintergerst KA, Buckingham B, Gandrud L, et al. Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit. Pediatrics. 2006;118:173-179.

Yendamuri S, Fulda GJ, Tinkoff GH. Admission hyperglycemia as a prognostic indicator in trauma. J Trauma. 2003;55:33-38.

Zerr KJ, Furnary AP, Grunkemeier GL, et al. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63:356-361.