Glucose control in the hospitalized elderly--a concern not just for patients with diabetes

Hyperglycemia is commonly noted yet undertreated among hospitalized patients. Older adults are particularly susceptible to the adverse effects of elevated glucose because of hyperglycemia-induced immune defects coupled with age-associated immune senescence. Although the American Diabetes Association (ADA) recommends maintaining fasting blood glucose (FBG) levels below 126 mg/dL and random glucose levels below 200 mg/dL in patients on general medical wards, there is limited evidence to support these targets since the recommendations are not based on randomized, controlled trials. We discuss the limitations of the current literature and present evidence from medical intensive-care studies that other glucose targets may lead to better outcomes. Furthermore, a study we conducted demonstrates that mild FBG elevations (100 to 126 mg/dL) were associated with increased morbidity among elderly patients on general medical wards. We advocate that all hospitalized patients be screened for hyperglycemia, and treatment should follow current ADA recommendations while studies are being completed to evaluate optimal targets.