Abstract
Abstract Hypoglycemia and hyperglycemia are associated with poor outcomes among hospitalized patients with type 2 diabetes (T2D). Until 2012, the American Diabetes Association (ADA) and Endocrine Society hospital clinical guideline recommended a target blood glucose (BG) of 70-140 mg/dl; however, more recently a relaxed target of 140-180 mg/dl has been recommended by the ADA. Little data from randomized clinical trials (RTC) is available to support an intensive vs relaxed BG target. Accordingly, we performed a post-hoc analysis on 9 RCTs to assess hospital outcomes in non-critically ill insulin-treated patients with T2D targeting BG 70-140 mg/dl vs. 140-180 mg/dl. Methods Among 1446 patients, 640 were treated to a target of 70-140 mg/dl and 806 to a target of 140-180 mg/dl. Propensity score matching was used to reduce the bias due to confounding in the estimation of the effect of BG target. The propensity score dependent variables upon model selection included sex, admission HbA1c, and home insulin use. The final propensity score matched study sample consisted of 1,146 patients (573 patients in each BG target group). Results There were no differences in age, gender, BMI, diabetes duration, home insulin use or hospital admission service (medicine/surgery). Patients in the intensive target BG group had lower mean BG (day 2-10: 163.73 ± 39.79 mg/dl vs 170.15 ± 39.94 mg/dl, p=0.004), less hyperglycemia (any BG >180: 86% vs 92%, p=0.003; any BG >240: 51% vs 62%, p<.001), similar rates of hypoglycemia (BG <70: 12% vs 15%, p=0.11; BG <54: 2.5% vs 4.0%, p=0.14), and trended towards greater time in range <180 mg/dl (62.00 ± 28.14% vs 59.23 ± 27.38%, p=0.06). The composite of complication rate (acute renal failure, infection, myocardial infarction, respiratory failure and stroke) was lower (3.7% vs 6.8%, p=0.02) in the intensive control group, with similar rates of inpatient death (0.9% vs 0.3%, p=0.36). Hospital length of stay was shorter in the intensive control group (4.0 vs 6.0 days, p<.001). Conclusion Our results indicate that tighter glycemic target of 70-140 mg/dl leads to lower mean daily BG, less severe hyperglycemia events, similar rates of hypoglycemia, and lower length of stay and complication rates compared to a higher target of 140-180 mg/dl. Further RCTs are indicated to elucidate optimal glycemic targets in hospitalized patients with T2D. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
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