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Guideline for intensive insulin therapy
A guideline from the American College of Physicians (ACP) recommends against aggressively controlling blood glucose in hospitalized patients. Intensive insulin therapy (IIT) is no longer recommended for patients in intensive care units, regardless of whether they have diabetes. Specifically, the ACP recommends not using IIT to strictly control blood glucose or even normalized blood sugar in surgical ICU or medical ICU patients, and recommends a target blood glucose level of 140-200 mg/dL if insulin therapy is used. The recommendation is based on multiple studies that show no reduction in mortality with a blood glucose target of 80-180 mg/dL compared with higher targets using a variety of intensive insulin regimens. This includes treatment of patients with myocardial infarction, stroke, acute brain injury, or those under perioperative care. The guideline further recommends that avoiding targets less than 140 mg/dL should be a priority because harm is likely with lower blood glucose targets (Ann Intern Med 2011;154:260-267).