American diabetes association 2009 standards of medical care diabetes care 2009 32. Hyperglycemia is a predictor of adverse outcomes, including mortality. As guest editor, i hope to provide you with many ideas and approaches to improving glycemic control in the acutecare setting. Johnston, md u ncontrolled hyperglycemia in hospitalized patients with or without a previous diagnosis of diabetes is associated with adverse outcomes and longer lengths of stay.
American diabetesassociation standards of medicalcare in diabetes 2018 inpatient hyperglycemia. Joint british diabetes societies recommend targeting glucose levels between 108 and 180 mgdl with an acceptable range of between 72 and 216 mgdl. The randomized study of basalbolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery rabbit 2 surgery trial showed that a basalbolus insulin regimen was associated with fewer hospital complications than slidingscale insulin. Target audience hospitalists, internists, family practitioners, emergency medicine physicians, endocrinologists, nurses, nurse practitioners, dietitians, pharmacists and other. Many people, especially those with type 1 diabetes, were admitted to the hospital at the time of diagnosis and spent several days learning how. Insulin infusion in infarction,7 digami2 diabe tes mellitus and acute myocardial infarction,8 and.
To develop insight into resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal management. We can and must do better for people with diabetes in hospital. Often the management of hyperglycemia and diabetes in hospitalized patients is a secondary concern compared to the condition that led to the patients hospitalization. Management of inpatient hyperglycemia and diabetes in older adults. Extensive data indicates that inpatient hyperglycemia, in patients with or. In 2017, an estimated 9,600 people required rescue treatment following a severe hypoglycaemic attack. Managing diabetes and hyperglycemia during hospitalization is vital for optimal clinical outcomes. Postoperatively, successful management of inpatient diabetes with the continuation of insulin pump therapy has been demonstrated in selected patients.
Disclaimer case studies inpatient diabetes management. Digami diabetes mellitus, insulin glucose infusion in acute myocardial infarction study group. Implementation and impact of glycemic management teams in 2004, the american college of endocrinology published a position statement outlining the rationale for inpatient glycemic control 17. Umpierrez will provide evidence supporting a consistent approach to initiating insulin in the hospital. In critically ill patients, intravenous iv insulin is most appropriate, with a starting threshold no higher. Inpatient management of diabetes can be a challenge, dr. A hospital stay for a person with diabetes can be a frightening experience and it is easy to understand why. Hospital inpatient management of diabetes reference number twcg4112 version 4 issue date. An individualized inpatient diabetes education and hospital transition program for poorly controlled hospitalized patients with diabetes. Despite the prevalence of diabetes and hyperglycemia among hospitalized patients, there have been limited guidelines and standards of care for inpatient blood glucose control. About 20 to 30% of patients have prior history of diabetes. Pdf inpatient management of hyperglycemia and diabetes.
This may occur in the icu or in the general ward, and evidence and guidelines differ between these settings. Diabetes resource center aace disease state resources. Inpatient management of diabetes and hyperglycemia among general medicine patients at a large teaching hospital. Inpatient hyperglycemia is common and is associated with an increased risk of hospital complications, higher healthcare resource utilization, and higher inhospital mortality rates. Hyperglycemia and acute coronary syndrome the endocrine society. Inpatient management of hyperglycemia and diabetes i feel as if we have come full circle in diabetes care. Inpatient management of hyperglycemia linkedin slideshare.
Inpatient hyperglycemia in people with or without diabetes is associated with an increased risk of complications and mortality, a longer hospital stay, a higher admission rate to the intensive. Pdf on mar 1, 20, szumita pm and others published inpatient management of hyperglycemia and diabetes. As guest editor, i hope to provide you with many ideas and approaches to improving glycemic control in. The safety and efficacy of sitagliptin, a dipeptidyl peptidase4 inhibitor, for the management of inpatient hyperglycemia was evaluated in a randomized pilot study in patients with type 2 diabetes treated at home with diet, oral antidiabetic agents, or a low daily insulin dose. Given the seriousness of this matter, i am delighted that this diabetes spectrum from research to practice section is devoted entirely to inpatient hyperglycemia management.
Role of the diabetes educator inpatient diabetes management. Glucose management in hospitalized patients poses challenges to physicians, including identifying blood glucose tar gets, judicious use of oral diabetes mellitus medications, and implementing. The prevalence of hyperglycemia is even higher and reported in 38% of patients. Pathways to quality inpatient management of hyperglycemia. Ensure you stay current with ongoing research developments and the latest treatment strategies for patients with diabetes and associated comorbidities using resources featured in aaces stateoftheart diabetes resource center. Inpatient diabetes management by specialized diabetes team. Significant improvements in mortality and morbidity with intensive glycemic management have been demonstrated in some randomized, controlled trials and in before and after comparisons. Care directed by a specialtytrained nurse practioner or physician assistant can overcome clinical inertia in management of inpatient diabetes. Inpatient glycemic management refers to identifying and treating hyperglycemia in the setting of acute illness in hospitalized patients with either preexisting diabetes or newonset hyperglycemia.
Out of 392 patients who met the eligibility criteria, 262 were matched 1. The joint british diabetes society for inpatient care jbdsip aims to improve inpatient diabetes care across the uk through the development and use of highquality, evidencebased guidelines and inpatient care pathways. Insulin is the best treatment for inpatient management but can be very challenging given the stress of illness, frequently changing caloric intake throughout the hospital stay, and limitations to care provided by hospital personnel. Quality of inpatient diabetes management journal of.
There is only one rct that examines the effect of glycemic control in nonintensive care unit icu settings. A call to action, authorboris draznin and janice l. Clinical diabetes volume 26, number 1, 2008 c a s e s t u d i e s case study. Hyperglycemia is common in critically ill patients, both with and without diabetes. Diabetes mellitus is a common comorbidity of hospitalization. Inpatient management of hyperglycemia and diabetes. Medical nutrition therapy is a key component of the comprehensive management of diabetes and hyperglycemia in the inpatient setting.
Conclusions treatment with sitagliptin alone or in combination with basal insulin is safe and effective for the management of hyperglycemia in general medicine and surgery patients with t2dm. Objective we compared the costeffectiveness of two inpatient diabetes care models. Inpatient american association of clinical endocrinologists. Inpatient management of diabetes and hyperglycemia clinical. In 20, diabetes was listed as a diagnosis in approximately 23% of all hospital discharges in the united states. Management of inpatient hyperglycemia and diabetes in. Pathways to quality inpatient management of hyperglycemia and diabetes. Maintaining adequate nutrition is important for glycemic control and to meet adequate caloric demands. Mayo clinic inpatient hyperglycemia and diabetes mellitus. Inpatient management of hyperglycemia knowledge for. Early in my nursing career, i began to focus on the care of people with diabetes in the hospital. Hyperglycemia is a common occurrence in hospitalized patients and for inpatients is defined as a blood glucose bg level 140 mgdl. Inpatient glycemic management symptoms, diagnosis and.
Diabetes at the front door march 2020 inpatient care of the frail older adult with diabetes october 2019. Glycemic control and sliding scale use in medical inpatients with diabetes mellitus. Highquality hospital care for diabetes requires both hospital care delivery standards, often assured by structured order sets, and quality assurance standards for process improvement. Management of diabetes and hyperglycemia in hospitalized. Management of hyperglycemia in the hospital setting. Inpatient management of diabetes and hyperglycemia. A call to action article pdf available in diabetes care 36. Because discharge diagnoses may not capture undiagnosed diabetes or hospitalrelated hyperglycemia, the true prevalence of diabetes or hyperglycemia in hospitalized patients is. The 2019 american diabetes association ada standards of medical care in diabetes on inpatient glycemic control recommends targeting glucose levels between 140 and 180 mgdl 7. A call to action boris draznin, md, phd 1 janice gilden, ms, md 2 sherita h. As part of a planned educational program, a questionnaire was designed and administered to determine the opinions of residents about the importance of inpatient glucose control, their perceptions about what glucose ranges were. Management of inpatient hyperglycemia and diabetes in older adults diabetes care 2017. Research design and methods we retrospectively evaluated 756 hospital admissions of patients with diabetes to noncritical care units over 6 months.
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