Management of Diabetes and Hyperglycemia in Hospitals

Clement, Stephen; Braithwaite, Susan S.; Magee, Michelle F.; Ahmann, Andrew J.; Smith, E. L.; Schafer, Rebecca G.; Hirsch, Irl B.

doi:10.2337/diacare.27.2.553

Cited by 1,103 publications

(868 citation statements)

References 456 publications

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“…Increasing evidence from observational and prospective interventional studies has shown that inpatient hyperglycemia is a predictor of poor clinical outcome of adult subjects. [3][4][5][6][7][8][9][10][11][12][13]16,17 Admission hyperglycemia has been associated with increased morbidity and mortality in patients with critical illness, as well as in non-critically ill adult subjects admitted to general surgical and medical wards. 3,6,18 In this study we also found that hyperglycemia is a common finding in children admitted with critical and noncritical illnesses and that most children had no history of diabetes before admission.…”

Section: Discussionmentioning

confidence: 99%

“…Extensive evidence from observational studies indicates that hyperglycemia in patients with or without a history of diabetes is an important marker of poor clinical outcome. [3][4][5][6][7][8][9][10][11][12] Several prospective randomized trials in patients with critical illness have shown that aggressive glycemic control improves short-and long-term mortality, multiorgan failure and systemic infection, and length of hospitalization. [13][14][15][16][17] The importance of glucose control also applies to adult patients admitted to general surgical and medical wards.…”

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confidence: 99%

“…[13][14][15][16][17] The importance of glucose control also applies to adult patients admitted to general surgical and medical wards. 3,6,18 In such patients, we recently reported that the presence of hyperglycemia is associated with prolonged hospital stay, infection, disability after hospital discharge, and death. 3,6,18 Despite the extensive data in adult patients, there is little information on the impact of inpatient hyperglycemia in pediatric patients.…”

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confidence: 99%

“…3,6,18 In such patients, we recently reported that the presence of hyperglycemia is associated with prolonged hospital stay, infection, disability after hospital discharge, and death. 3,6,18 Despite the extensive data in adult patients, there is little information on the impact of inpatient hyperglycemia in pediatric patients. The few observational studies in critically ill children admitted to the pediatric ICU with severe brain injury or extensive burn injuries have shown a positive association between inpatient hyperglycemia and increased length of hospital and ICU stay and a higher risk of complication and mortality rates.…”

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confidence: 99%

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Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Palacio

Smiley

Cerón

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:Inpatient hyperglycemia in adult patients with and without a history of diabetes is a predictor of poor clinical outcome. No previous studies, however, have examined the association of hyperglycemia and clinical outcome in children admitted to a community pediatric hospital.METHODS:The study was a retrospective observational cohort of pediatric patients admitted to a community children's hospital from January 2004 to August 2004. Medical records of 903 consecutive children admitted to critical and non–critical care areas were reviewed. Of them, 342 patients (38%) had no blood glucose measurements during their hospital stay. In the remaining patients, we determined the prevalence of hyperglycemia and examined the association of hyperglycemia with clinical outcome.RESULTS:A total of 406 patients (75%) had an admission blood glucose ≤120 mg/dL (mean ± SEM 98 ± 1 mg/dL), 103 children (19%) had an admission blood glucose level of 121–179 mg/dL (mean 143 ± 2 mg/dL), and 32 patients (5.9%) had a blood glucose level ≥180 mg/dL (mean 260 ± 18 mg/dL). Seventeen patients (13%) had a known history of diabetes prior to admission. Children with hyperglycemia were more likely to be admitted to the ICU (P < .001) and had a longer length of ICU stay (P < .001), but admission hyperglycemia was not associated with longer hospital stay or higher hospital mortality.CONCLUSIONS:Hyperglycemia is present in one‐fourth of children admitted to the hospital, most of them without a history of diabetes prior to admission. Hyperglycemia was associated with a greater need for ICU care and longer ICU stay but not with increased in‐hospital mortality. Journal of Hospital Medicine 2008;3:212–217. © 2008 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Palacio

Smiley

Cerón

et al. 2008

Journal of Hospital Medicine

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“…[1][2][3] Estimates of prevalence of diabetes mellitus in hospitalized adult patients range from 12% to 25%. 4 Hyperglycemia is a strong predictor of adverse clinical outcome in a range of diseases such as acute stroke, congestive heart failure, communityacquired pneumonia, and acute myocardial infarction. [5][6][7][8] Hyperglycemia is also a risk factor for surgical infection in patients undergoing cardiac surgery.…”

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Evaluation of hospital glycemic control at US Academic Medical Centers

Boord

Greevy

Braithwaite

et al. 2009

Journal of Hospital Medicine

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OBJECTIVE:To evaluate contemporary hospital glycemic management in US academic medical centers.DESIGN: This retrospective cohort study was conducted on patients discharged from 37 academic medical centers between July 1 and September 30, 2004; 1,718 eligible adult patients met at least 1 of the inclusion criteria: 2 consecutive blood glucose readings >180 mg/dL within 24 hours, or insulin treatment at any time during hospitalization. We assessed 3 consecutive measurement days of glucose values, glycemic therapy, and additional clinical and laboratory characteristics. RESULTS:In this diverse cohort, 79% of patients had a prior diagnosis of diabetes, and 84.6% received insulin on the second measurement day. There was wide variation in hospital performance of recommended hospital diabetes care measures such as glycosylated hemoglobin (A1C) assessment (range, 3%-63%) and timely admission laboratory glucose measurement (range, 39%-97%). Median glucose was significantly lower for patients in the intensive care unit (ICU) compared to ward/intermediate care. ICU patients treated with intravenous insulin had significantly lower median glucose when compared to subcutaneous insulin. Only 25% of ICU patients on day 3 had estimated 6 AM glucose 110 mg/dL.Hyperglycemia was common, 50% of all patients had !1 glucose measurement !180 mg/dL on measurement days 2 and 3. Severe hypoglycemia (<50 mg/dL) occurred in 2.8% of all patient days. CONCLUSIONS:Despite frequent insulin use, glucose control was suboptimal.

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Literature Review and Global Consensus on Management of Acute Radiation Syndrome Affecting Nonhematopoietic Organ Systems

Dainiak¹,

Gent²,

Carr³

et al. 2011

Disaster med. public health prep.

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ABSTRACTObjectives:The World Health Organization convened a panel of experts to rank the evidence for medical countermeasures for management of acute radiation syndrome (ARS) in a hypothetical scenario involving the hospitalization of 100 to 200 victims. The goal of this panel was to achieve consensus on optimal management of ARS affecting nonhematopoietic organ systems based upon evidence in the published literature.Methods:English-language articles were identified in MEDLINE and PubMed. Reference lists of retrieved articles were distributed to conferees in advance of and updated during the meeting. Published case series and case reports of ARS, publications of randomized controlled trials of relevant interventions used to treat nonirradiated individuals, reports of studies in irradiated animals, and prior recommendations of subject matter experts were selected. Studies were extracted using the Grading of Recommendations Assessment Development and Evaluation system. In cases in which data were limited or incomplete, a narrative review of the observations was made.Results:No randomized controlled trials of medical countermeasures have been completed for individuals with ARS. Reports of countermeasures were often incompletely described, making it necessary to rely on data generated in nonirradiated humans and in experimental animals. A strong recommendation is made for the administration of a serotonin-receptor antagonist prophylactically when the suspected exposure is >2 Gy and topical steroids, antibiotics, and antihistamines for radiation burns, ulcers, or blisters; excision and grafting of radiation ulcers or necrosis with intractable pain; provision of supportive care to individuals with neurovascular syndrome; and administration of electrolyte replacement therapy and sedatives to individuals with significant burns, hypovolemia, and/or shock. A strong recommendation is made against the use of systemic steroids in the absence of a specific indication. A weak recommendation is made for the use of fluoroquinolones, bowel decontamination, loperamide, and enteral nutrition, and for selective oropharyngeal/digestive decontamination, blood glucose maintenance, and stress ulcer prophylaxis in critically ill patients.Conclusions:High-quality studies of therapeutic interventions in humans exposed to nontherapeutic radiation are not available, and because of ethical concerns regarding the conduct of controlled studies in humans, such studies are unlikely to emerge in the near future.(Disaster Med Public Health Preparedness. 2011;5:183–201)

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Management of Diabetes and Hyperglycemia in Hospitals

Cited by 1,103 publications

References 456 publications

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Evaluation of hospital glycemic control at US Academic Medical Centers

Literature Review and Global Consensus on Management of Acute Radiation Syndrome Affecting Nonhematopoietic Organ Systems

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