Hyperglycemia and Hospital Transitions: Still A Long Road Ahead

Abstract

Hyperglycemia, regardless of diabetes status, is present in over 30% of patients in an inpatient care setting and is an independent marker of mortality ( 1. Umpierrez G.E. Isaacs S.D. Bazargan N. You X. Thaler L.M. Kitabchi A.E. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002; 87: 978-982 Crossref PubMed Scopus (1551) Google Scholar ). As diabetes rates increase, appropriate transitions between care settings are needed for those with new-onset hyperglycemia and with diabetes mellitus (DM). Hospital discharges for DM increased from 2.8 million to 5.5 million between 2010 and 2014 ( 2. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. Statistics About Diabetes. 2014. Available at: http://www.cdc.gov/diabetes/statistics/hospitalization_national.htm. Accessed July 20, 2015 Google Scholar ). Antihyperglycemia treatments can pose risks to patients, as both insulin and oral agents have been identified as common medications leading to hospitalizations due to adverse drug events ( 3. Budnitz D.S. Lovegrove M.C. Shehab N. Richards C.L. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011; 365: 2002-2012 Crossref PubMed Scopus (1316) Google Scholar ). Acute-care transitions are considered particularly prone to medical error by the Joint Commission on Accreditation of Healthcare Organizations, as they result in complications and communication breakdowns that have consistently been at the root of a high percentage of reported events resulting in death or serious injury ( 4. Ong M.S. Coiera E. A systematic review of failures in handoff communication during intrahospital transfers. Jt Comm J Qual Patient Saf. 2011; 37: 274-284 Abstract Full Text Full Text PDF PubMed Google Scholar ).