Inpatient diabetes management in general medical and surgical settings: evidence and update

Abstract

A quarter of patients who are hospitalized for any reason have diabetes as a comorbid condition. Despite this, management of diabetes among inpatients has historically been a low clinical priority. Since the publication of several landmark trials demonstrating the benefits of intensive glycemic control in the surgical intensive care unit, inpatient glycemic control on general hospital wards has received increased attention. Physicians and healthcare organizations in the USA have recently advocated more aggressive treatment of inpatient hyperglycemia despite the lack of data to guide evidence-based management in general (non-intensive care unit) settings. These calls to action have prompted a series of studies that demonstrate effective systems-based strategies for measuring and improving inpatient glycemic control, even though it is not yet clear how aggressively this goal should be pursued. While the data on improved long-term outcomes related to improved glycemic control in general inpatient settings are sparse, at the very least, inpatient diabetes management is likely to be beneficial if it prevents extremes of hyper- and hypoglycemia, decreases medication error, and facilitates improved outpatient medication regimens and self-management skills, which, in turn, may lead to improved glycemic control after discharge.

The future of inpatient diabetes management: glucose as the sixth vital sign

“…In light of the conflicting results of the major trials of intensive in-hospital management of diabetes, it was logical to propose that the goal should be to normalize glycemic levels while avoiding hypoglycemia [33] . The evidence favoring tight glycemic control in patients on general medical and surgical wards is not as strong as that for critically ill patients [34][35][36] .…”

Glucose control in non‐critically ill inpatients with diabetes: towards closed‐loop

“…A survey of inpatient diabetes management in hospitals across the US revealed that both hyper-and hypoglycaemia was common [23]. A survey of inpatient diabetes management in hospitals across the US revealed that both hyper-and hypoglycaemia was common [23].…”

“…Shortcomings of inpatient diabetes care have been highlighted by national audits in several countries. A survey of inpatient diabetes management in hospitals across the US revealed that both hyper-and hypoglycaemia was common [23]. Over a third of diabetes inpatients in 29 hospitals had blood glucose values above 11.1 mmol/l for three consecutive days, and those on insulin had more frequent and severe hypoglycaemia.…”