Unrecognized Diabetes Among Hospitalized Patients

Levetan, Claresa; Passaro, Maureen; Jablonski, Kathleen A.; Kass, Mary E.; Ratner, Robert E.

doi:10.2337/diacare.21.2.246

Cited by 282 publications

(172 citation statements)

References 20 publications

Supporting

Mentioning

156

Contrasting

Unclassified

Order By: Relevance

“…Many factors could explain the lack of glycemic control in the hospital. First, the overwhelming majority of hospitalizations in patients with hyperglycemia occur for a variety of comorbid conditions (1,2,20), with Ͻ10% of hospital discharges in the U.S. listing diabetes as the primary diagnosis (5). Second, physicians often perceive hyperglycemia as a consequence of stress and acute illness and often delay treatment until blood glucose levels exceed 200 mg/dl (2,21).…”

Section: B Sliding Scale Regimen With Regular Insulinmentioning

confidence: 99%

Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes (RABBIT 2 Trial)

et al. 2007

View full text Add to dashboard Cite

OBJECTIVE -We sought to study the optimal management of hyperglycemia in nonintensive care unit patients with type 2 diabetes, as few studies thus far have focused on the subject.RESEARCH DESIGN AND METHODS -We conducted a prospective, multicenter, randomized trial to compare the efficacy and safety of a basal-bolus insulin regimen with that of sliding-scale regular insulin (SSI) in patients with type 2 diabetes. A total of 130 insulin-naive patients were randomized to receive glargine and glulisine (n ϭ 65) or a standard SSI protocol (n ϭ 65). Glargine was given once daily and glulisine before meals at a starting dose of 0.4 units ⅐ kg Ϫ1 ⅐ day Ϫ1 for blood glucose 140 -200 mg/dl or 0.5 units ⅐ kg Ϫ1 ⅐ day Ϫ1 for blood glucose 201-400 mg/dl. SSI was given four times per day for blood glucose Ͼ140 mg/dl. RESULTS -The mean admission blood glucose was 229 Ϯ 6 mg/dl and A1C 8.8 Ϯ 2%. A blood glucose target of Ͻ140 mg/dl was achieved in 66% of patients in the glargine and glulisine group and in 38% of those in the SSI group. The mean daily blood glucose between groups ranged from 23 to 58 mg/dl, with an overall blood glucose difference of 27 mg/dl (P Ͻ 0.01). Despite increasing insulin doses, 14% of patients treated with SSI remained with blood glucose Ͼ240 mg/dl. There were no differences in the rate of hypoglycemia or length of hospital stay.CONCLUSIONS -Treatment with insulin glargine and glulisine resulted in significant improvement in glycemic control compared with that achieved with the use of SSI alone. Our study indicates that a basal-bolus insulin regimen is preferred over SSI in the management of non-critically ill, hospitalized patients with type 2 diabetes. Diabetes Care 30:2181-2186, 2007H yperglycemia in hospitalized patients is a common, serious, and costly health care problem with profound medical consequences. Increasing evidence indicates that the development of hyperglycemia during acute medical or surgical illness is not a physiologic or benign condition but is a marker of poor clinical outcome and mortality (1-3). Extensive evidence from observational studies, including our own, indicates that in hospitalized patients with critical illness, hyperglycemia is associated with an increased risk of complications and mortality (3-9). Prospective randomized trials in critically ill patients have shown that intensive glucose control reduces the risk of multiorgan failure, systemic infections, and short-and longterm mortality. Effective management of hyperglycemia is also associated with a decreased length of intensive care unit and hospital stay (4,6,8 -10) and decreased total hospitalization cost (11). The importance of glycemic control on outcome is not limited to patients in critical care areas but also applies to patients admitted to general surgical and medical wards. In such patients, the presence of hyperglycemia has been associated with prolonged hospital stay, infection, disability after hospital discharge, and death (1,5,12). In general surgery patients, the relative risk for serious postopera...

show abstract

Section: B Sliding Scale Regimen With Regular Insulinmentioning

confidence: 99%

Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes (RABBIT 2 Trial)

et al. 2007

View full text Add to dashboard Cite

show abstract

“…1,2 Hyperglycemia is present in 38% of adults admitted to the hospital, one third of whom had no history of diabetes before admission. 3 The impact of inpatient hyperglycemia on clinical outcome in adult patients has been increasingly appreciated.…”

mentioning

confidence: 99%

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

Palacio

Smiley

Cerón

et al. 2008

Journal of Hospital Medicine

View full text Add to dashboard Cite

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.

show abstract

“…Uncontrolled diabetes is a significant risk factor for postoperative infection following total joint arthroplasty, spine procedures, and foot and ankle surgery [2][3][4] . However, nearly one-third of patients who are admitted to the hospital without a history of diabetes have hyperglycemia 5 , which is associated with longer hospital stay, higher rates of admission to the intensive care unit (ICU), and increased mortality 6 . Elevated perioperative serum blood glucose levels in general surgery patients increase the risk of postoperative infections, independent of diabetic status 7,8 .…”

mentioning

confidence: 99%

Relationship of Hyperglycemia and Surgical-Site Infection in Orthopaedic Surgery

Richards

Kauffmann

Zuckerman

et al. 2012

The Journal of Bone & Joint Surgery

172

105

View full text Add to dashboard Cite

Unrecognized Diabetes Among Hospitalized Patients

Cited by 282 publications

References 20 publications

Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes (RABBIT 2 Trial)

Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes (RABBIT 2 Trial)

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

Relationship of Hyperglycemia and Surgical-Site Infection in Orthopaedic Surgery

Contact Info

Product

Resources

About