Article Summary Position Statement of the American College of Endocrinology and American Association of Clinical Endocrinologists: Consensus Development Conference on Inpatient Diabetes and Metabolic Control December 16, 2003. Available at: www.ACE.com . Objective: A number of guidelines exist for the outpatient management of patients with diabetes, but no such guidelines have been formulated for inpatient management. Yet, diabetes is a common comorbid condition in nearly 10% of all patients discharged from hospitals and nearly 30% of all patients undergoing cardiac surgery. Further, the prevalence of hyperglycemia in the hospital setting significantly increases morbidity and mortality even in patients with no previous history of diabetes. To address the issue of hyperglycemia in the hospital setting, the American College of Endocrinology and the American Association of Clinical Endocrinologists convened a critical consensus panel to formulate standard treatment targets for this patient population. Methods: The panel addressed a number of questions by evaluating numerous clinical trials and meta-analyses: 1) What evidence exists that in-hospital hyperglycemia is associated with adverse outcomes? 2) Does reduction of hyperglycemia improve outcomes? 3) To what extent does the impact of metabolic regulation extend beyond merely glycemic regulation? 4) What targets should be attained? 5) What methods for such regulation should be used? 6) What is the molecular basis for improved outcomes? 7) What are the needs for future research? Recommendations: Based on the results of the evaluated trials, the panel recommends that to support improved outcomes in the intensive care unit, blood glucose levels should not exceed 110 mg/dL. In noncritical care units, preprandial glycemic targets should not exceed 110 mg/dL, with maximal glucose concentrations being below 180 mg/dL. The panel also suggests that glycemic values greater than 180 mg/dL signify the need for frequent monitoring so that the need for intensive intervention pre- and post-discharge can be determined. Preprandial target levels during pregnancy should not exceed 100 mg/dL; 1-hour postprandial levels should not exceed 120 mg/dL. Several protocols for continuous intravenous insulin (CII) therapy and subcutaneous insulin therapy are effective in controlling hyperglycemia in the hospital setting. Studies show that treatment protocols developed by multidisciplinary hospital teams can control hyperglycemia and decrease rates of hypoglycemia. Hospital systems should therefore be assessed for safety and quality of care. Conclusion: Data from numerous studies confirm that hospitalized patients who experience hyperglycemic events are at increased risk for morbidity, mortality, increased length of stay, and unfavorable post-discharge outcomes. Significant hyperglycemia in the hospital requires close follow-up after discharge regardless of the reasons for hospitalization. Patients with no prior history of diabetes who experience hyperglycemic episodes require follow-up laboratory studies, including fasting blood glucose concentration, 2-hour postprandial glucose concentration, and oral glucose tolerance testing.