Inpatient diabetes control: rationale.

Abstract

This is the first of two articles on the Consensus Development Conference on Inpatient Diabetes Control, which was sponsored by the American College of Endocrinology and held in Washington, DC, 14–15 December 2003. Donald Bergman (New York, NY), President of the American Association of Clinical Endocrinologists, suggested the importance of endocrinologists beginning “to partner … for practical reasons,” perhaps in this one fashion emulating trial lawyers and the National Rifle Association by finding strength in numbers! Nathaniel Clarke, on behalf of the American Diabetes Association, which cosponsored the meeting, stressed the importance of developing common conclusions and guidelines. Representatives of the Endocrine Society, the American Association of Diabetes Educators, the Society of Hospital Medicine, and the American Society of Anesthesiologists agreed on the importance of the topic. Alan Garber (Houston, TX), who moderated the conference, pointed out the frequency of diabetes among hospitalized persons and noted that at his institution, approximately one-third of persons in the coronary care unit have diabetes, with one-third of this group having glucose levels ≥200 mg/dl. There are, he noted, few existing standards for glycemic control of persons with diabetes in hospital. Robert Frye (Rochester, MN) gave “a historical perspective” of the rationale for the Bypass Angioplasty Revascularization Investigation (BARI) study of patients with multivessel coronary disease, with objective evidence of ischemia and without prior revascularization. At the time of patient enrollment in the study, the majority of patients were considered unsuitable for angioplasty, so that only a minority of potential patients were randomized, leading to some uncertainty as to whether the results can be fully generalized. Diabetes was prespecified as a subgroup by the data monitoring and safety group, with 19% of those enrolled having treated diabetes, although diabetes was not prespecified for analysis of outcome, which has been another source of controversy about …