Abstract
Diabetes and hyperglycemia are present in over one-third of inpatients in internal medicine units and are associated with worse prognosis in multiple morbidities. Treatment of inpatient hyperglycemia is usually with basal bolus insulin in a dose calculated by the patient’s weight, with lower doses recommended in patients who are at a higher risk for hypoglycemia. Other antihyperglycemic medications and insulin regimens can be used in selected patients. There are no adequately powered studies on the effect of improving glycemic control on hospitalization outcomes in non-critically ill patients in internal medicine units, and in most patients a modest glucose target of 140–180 mg/dL is recommended. A structured discharge plan should intensify antihyperglycemic treatment as needed and include an outpatient follow-up appointment shortly after discharge.
Highlights
Diabetes and hyperglycemia are present in over one-third of inpatients in internal medicine units and are associated with worse prognosis in multiple morbidities
Because discharge orders are based on prior glycemic control as reflected in admission hemoglobin A1c (HbA1c) levels, guidelines recommend performing an HbA1c test on all patients with diabetes or hyperglycemia admitted to the hospital if there are no up-to-date results from the prior 3 months
Hyperglycemia is common in internal medicine units, and the recommended treatment is basal bolus insulin
Summary
Diabetes and hyperglycemia are present in up to 45% of inpatients in internal medicine units.[1,2,3] In the majority of cases hyperglycemia is not the primary reason for hospitalization, but in many cases it contributes to the conditions that led to hospitalization, such as cardiovascular events, heart failure, renal failure, and infections. These diagnoses are all more prevalent in patients with diabetes, and the pathophysiology through which hyperglycemia causes or worsens these conditions has been well characterized. Conflict of interest: No potential conflict of interest relevant to this article was reported
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