What is the target blood glucose (BG) range for a hospitalized patient with type 2 diabetes mellitus (T2DM), like Vivianne, according to the American Diabetes Association (ADA) standards of care?

Target Blood Glucose Range for Hospitalized Patients with Type 2 Diabetes

The target blood glucose range for Vivianne, an 80-year-old female with type 2 diabetes mellitus hospitalized on the surgical floor, should be 140-180 mg/dL according to the American Diabetes Association (ADA) standards of care for diabetes care in the hospital. 1

Evidence Supporting the 140-180 mg/dL Target Range

The American Diabetes Association specifically recommends a target blood glucose range of 140-180 mg/dL for most hospitalized patients with diabetes, including both critically ill and non-critically ill patients like Vivianne 1. This recommendation is supported by several key considerations:

• This range balances the risks of hyperglycemia with the dangers of hypoglycemia
• The landmark NICE-SUGAR trial demonstrated higher mortality with more intensive glycemic control and significantly greater rates of hypoglycemia with tighter targets 1
• Targets below 110 mg/dL should be avoided due to increased risk of hypoglycemia and mortality 1

Special Considerations for Vivianne's Case

Several factors in Vivianne's case make the 140-180 mg/dL range particularly appropriate:

• Advanced age (80 years): Elderly patients have increased risk of hypoglycemia 1
• Recent trauma (head laceration and facial fracture): Recent trauma is a risk factor for hypoglycemia 1
• Pending surgery: The perioperative period presents risk of interrupted nutrition, which can increase hypoglycemia risk 1
• Non-ICU setting: She is on a surgical floor, not in intensive care, where the 140-180 mg/dL range is still appropriate 1, 2

Alternative Target Ranges and Why They're Not Appropriate for Vivianne

1. 110-140 mg/dL:

   • While more stringent goals may be appropriate for selected patients such as post-surgical or cardiac surgery patients 1, this range would be too aggressive for Vivianne given her age and recent trauma
   • This tighter range is associated with increased hypoglycemia risk 3

2. 150-200 mg/dL:

   • While patients with severe comorbidities may have higher targets up to 200-250 mg/dL 1, there's no indication Vivianne has such severe comorbidities to warrant this higher range

3. 100-180 mg/dL:

   • The lower bound (100 mg/dL) is too aggressive and approaches ranges that have been associated with increased hypoglycemia risk 1, 4

Implementation Considerations

For Vivianne's care, the following should be implemented:

• Insulin therapy should be initiated if blood glucose is ≥180 mg/dL (checked on two occasions) 1
• A basal-bolus insulin regimen is preferred over sliding scale insulin alone 1, 5
• Point-of-care blood glucose monitoring should be performed before meals if she is eating, and every 4-6 hours if not eating 1
• Careful monitoring during the perioperative period when nutritional intake may be inconsistent 1
• Insulin doses should be adjusted every 2-3 days based on patterns 1

Common Pitfalls to Avoid

• Avoid sliding scale insulin alone: This approach is strongly discouraged as it is less effective than basal-bolus regimens 1, 5
• Avoid targets below 110 mg/dL: These increase hypoglycemia risk without providing additional benefit 1, 4
• Avoid failure to adjust for perioperative period: Special attention to glucose management is needed during this time 1
• Avoid ignoring hypoglycemia risk factors: Vivianne's advanced age and recent trauma increase her hypoglycemia risk 1