Too Much Confidence, Too Little Knowledge

Abstract

Multiple studies have shown an association between blood glucose (BG) levels and clinical outcomes in hospitalized patients ( 1. Murad M.H. Coburn J.A. Coto-Yglesias F. et al. Glycemic control in non-critically ill hospitalized patients: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012; 97: 49-58 Crossref PubMed Scopus (131) Google Scholar ). Both hyperglycemia and hypoglycemia are associated with increased mortality and morbidity ( 1. Murad M.H. Coburn J.A. Coto-Yglesias F. et al. Glycemic control in non-critically ill hospitalized patients: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012; 97: 49-58 Crossref PubMed Scopus (131) Google Scholar ). Experts from different professional organizations have suggested slightly different goals but mostly they are within a range of 80 to 200 mg/dL ( 2. American Diabetes Association 15. Diabetes care in the hospital: standards of medical care in diabetes-2019. Diabetes Care. 2019; 42: S173-S181 Crossref PubMed Scopus (155) Google Scholar ). There is consensus about preventing very high and very low BG levels. Besides professional society guidelines, glycemic control to prevent complications of hyperglycemia or hypoglycemia makes common sense. Therefore, many hospitals have set up inpatient glycemic control programs. However, despite a high emphasis on glycemic control in the hospital setting, overall glycemic control remains inadequate in most hospitals ( 5. Cook C.B. Kongable G.L. Potter D.J. Abad V.J. Leija D.E. Anderson M. Inpatient glucose control: a glycemic survey of 126 US hospitals. J Hos Med. 2009; 4: E7-E14 Crossref PubMed Scopus (142) Google Scholar , 6. Draznin B. Gilden J. Golden S.H. Inzucchi S.E. Pathways to quality inpatient management of hyperglycemia and diabetes: a call to action. Diabetes Care. 2013; 36: 1807-1814 Crossref PubMed Scopus (118) Google Scholar ). A study of data obtained from 575 hospitals in the United States revealed about 32% of the hospital patient days with at least 1 BG value above 180 mg/dL and about 6% hospital days with at least 1 BG value below 70 mg/dL ( 7. Swanson C.M. Potter D.J. Kongable G.L. Cook C.B. Update on inpatient glycemic control in hospitals in the United States. Endocr Pract. 2011; 17: 853-861 Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar ). Requests for diabetes consults are rather infrequent, even in hospitals with well-established inpatient diabetes management programs. In a recent study, only 13% of the elective surgery patients with diabetes received a diabetes consult and this number increased to 32% after implementation of a major quality improvement program ( 8. Garg R. Schuman B. Bader A. et al. Effect of preoperative diabetes management on glycemic control and clinical outcomes after elective surgery. Ann Surg. 2018; 267: 858-862 Crossref PubMed Scopus (52) Google Scholar ). The number of diabetes consults at other hospitals with less established inpatient diabetes programs are likely to be much smaller.