Abstract
Differing blood glucose (BG) targets are recommended by professional organizations in noncritical care settings. Previous Endocrine Society and ADA guidelines recommended a target BG of 70-140 and 140-180 mg/dl; however, the 2023 ADA Standards of Care recommends a target of 100-180 mg/dl. The lack of consensus is due to the lack of randomized clinical trials (RTC) to support a tight vs relaxed BG target. We performed a post-hoc analysis on 9 RCTs to assess hospital outcomes in non-critically ill insulin-treated subjects with T2D targeting BG 70-140 mg/dL vs. 140-180 mg/dL. 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 including sex, HbA1c, and home insulin use, for a final count of 1,146 patients (573 subjects in each target group). Patients in the tight BG target group had lower mean BG (163.73±39.79 vs 170.15±39.94 mg/dL, p=0.004), less hyperglycemia (BG >180: 86% vs 92%, p=0.003; 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). The intensive target resulted in a shorter length of stay (4.0 vs 6.0 days, p<.001) and lower composite of complication rate (acute kidney injury, infection, myocardial infarction, respiratory failure and stroke) (3.7% vs 6.8%, p=0.02) than the relaxed BG target, with similar mortality rates (0.9% vs 0.3%, p=0.36). There were no differences in glycemic variability (GV) between groups with greater GV in those experiencing hypoglycemia <70 mg/dL or hyperglycemia >200 mg/dL. Our results indicate that lower BG target of 70-140 mg/dl leads to lower mean daily BG, less severe hyperglycemia events, similar rates of hypoglycemia and glycemic variability, and lower length of stay and complication rates compared to a higher target of 140-180 mg/dl. RCTs are indicated to elucidate optimal glycemic targets in hospitalized patients with T2D. Disclosure J.Saling: None. A.L.Migdal: None. M.A.Urrutia: None. Z.Zabala: None. B.Moazzami: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. M.Fayfman: None. A.A.Rashied: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. Funding Jacob Family Funds
