Target Blood Glucose Range for Hospitalized Patients with Type 2 Diabetes
The target blood glucose (BG) range for Vivianne, an 80-year-old hospitalized patient with type 2 diabetes mellitus, is 140-180 mg/dL according to the American Diabetes Association (ADA) standards of care for diabetes care in the hospital. 1, 2
Evidence-Based Rationale
Current Guidelines
- The ADA's 2023 and 2024 Standards of Care in Diabetes explicitly recommend a target glucose range of 140-180 mg/dL (7.8-10.0 mmol/L) for most hospitalized patients with diabetes, including both critically ill and non-critically ill patients 1
- This recommendation applies to Vivianne's case as she is:
- A non-critically ill patient (on a surgical floor, not in ICU)
- Awaiting surgery for facial fracture
- Has type 2 diabetes mellitus
Evolution of Glycemic Targets
- Earlier studies suggested benefits from tighter glycemic control (80-110 mg/dL)
- However, the landmark NICE-SUGAR trial demonstrated:
- Higher mortality with intensive glycemic control
- 10-15 fold greater rates of hypoglycemia with tighter targets 1
- Based on this evidence, the ADA revised its recommendations to the current 140-180 mg/dL target range
Implementation for Vivianne's Case
- Insulin therapy should be initiated if her blood glucose is ≥180 mg/dL (confirmed on two occasions) 1
- Once insulin therapy is started, the target range should be maintained at 140-180 mg/dL
- Point-of-care blood glucose monitoring should be performed:
- Before meals if she is eating
- Every 4-6 hours if she is not eating 1
Alternative Targets and Considerations
- More stringent goals (110-140 mg/dL) may be appropriate for selected patients, particularly post-surgical patients, but only if achievable without significant hypoglycemia 1
- The target of 100-180 mg/dL is not specifically recommended in the most recent ADA guidelines
- The target of 150-200 mg/dL is higher than current recommendations
- The target of 110-140 mg/dL is more stringent than generally recommended and carries increased risk of hypoglycemia 3
Potential Pitfalls and Caveats
- Hypoglycemia risk factors in Vivianne's case:
- Advanced age (80 years)
- Recent trauma
- Potential for interrupted nutrition during perioperative period
- Sliding scale insulin alone is strongly discouraged; a basal-bolus insulin regimen is preferred for non-critically ill patients 1, 2
- Careful monitoring is essential during the perioperative period when nutritional intake may be inconsistent
- Glucose targets should be reassessed after surgery based on her clinical condition
The 140-180 mg/dL target range represents the optimal balance between preventing hyperglycemia-related complications while minimizing the risk of dangerous hypoglycemic events in hospitalized patients like Vivianne.