Inpatient Diabetes Management

Abstract

The epidemic of diabetes continues to flourish in the United States and throughout the world. Nowhere is the diabetes epidemic as apparent as in the inpatient hospital setting. Diabetes mellitus increases the risk of disorders such as coronary artery disease, cerebrovascular occlusion, peripheral artery disease, renal insufficiency, peripheral neuropathy, lower-extremity infection, ulceration, and amputation, and other disorders. Such complications frequently require admission into the hospital for evaluation and treatment. It is not surprising, therefore, that patients with diabetes compose a disproportionately high number of hospital inpatients. Approximately 12-25% of hospitalized patients have diabetes, and the diagnosis of diabetes at hospital admission has increased 2.3-fold to 5.1 million from 1980 to 2003. An increasing number of studies have associated hyperglycemia with adverse outcomes during hospitalization, but outcomes of interventional studies that attempt to decrease such complications by aggressively treating hyperglycemia are mixed.1,2 It has long been observed that patients with diabetes or who develop hyperglycemia in response to the stress of illness may have poor hospital outcomes and higher rates of complications when hospitalized. This trend has shown itself in patients with mild degrees of illness and small surgical procedures, as well as critically ill patients and those undergoing major surgery. Recently, several studies have attempted to quantify the increased risk of patients with diabetes in the hospital setting and determine whether aggressive intervention improves such risks. One of the first studies that attempted to actually quantify the extent of increased risk to noncritically ill patients was conducted by Umpierrez et al.3 They analyzed the hospital records of more than 2,000 patients who were admitted in general hospital wards in a community hospital. The study included both medical and surgical patients. Of the patients studied, 26% had known diabetes, and 12% were newly diagnosed as hyperglycemic based …