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Management of Diabetes and Hyperglycemia in the Hospital Setting

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Principles of Diabetes Mellitus

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Abstract

Diabetes mellitus is a disease commonly encountered in the hospital setting; however, management of glycemia in the hospitalized patient has been extremely variable over the past two decades. It has been well established that diabetes increases length of stay, complications, and mortality in the hospitalized patient. This chapter reviews the retrospective data which direct us to focus on glycemic management of inpatients. Prospective data follow and focus on specific glycemic targets and practices which have been under debate. Current inpatient glycemic targets have evolved over the past decade and have been refined based on the specific hospital setting. A review of glycemic targets in the critical care and noncritical care setting is explored.

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References

  1. Mainous III AG, Baker R, Koopman RJ, et al. Impact of the population at risk of diabetes on projections of diabetes burden in the United States: an epidemic on the way. Diabetologia. 2007;50:934–40.

    Article  PubMed  PubMed Central  Google Scholar 

  2. CDC. National Hospital Discharge Survey. 2010. www.cdc.gov

  3. Sunny K. Burden of hospitalizations primarily due to uncontrolled diabetes. Diabetes Care. 2007;30:1281–2.

    Article  Google Scholar 

  4. Maciejewski ML, Maynard C. Diabetes-related utilization and costs for inpatient and outpatient services in the veterans administration. Diabetes Care. 2004;27:B69–73.

    Article  PubMed  Google Scholar 

  5. UKPDS Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.

    Article  Google Scholar 

  6. The DCCT Research Group. Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA. 2002;287:2563–9.

    Article  Google Scholar 

  7. Inzucchi SE. Management of hyperglycemia in the hospital setting. N Engl J Med. 2006;355:1903–11.

    Article  CAS  PubMed  Google Scholar 

  8. Woods SE, Smith MJ, Sohail S, et al. The influence of type 2 diabetes mellitus in patients undergoing coronary artery bypass graft surgery: an 8-year prospective cohort study. Chest. 2004;126:1789–95.

    Article  PubMed  Google Scholar 

  9. Donahoe SM, Stewart GC, McCabe CH, et al. Diabetes and mortality following acute coronary syndromes. JAMA. 2007;298:765–75.

    Article  CAS  PubMed  Google Scholar 

  10. Gudmundsson G, Gislason T, Lindberg E, et al. Mortality in COPD patients discharged from hospital: the role of treatment and co-morbidity. Respir Res. 2006;7:109–17.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Dronge AS, Perkal MF, Kancir S, et al. Long-term glycemic control and postoperative infectious complications. Arch Surg. 2006;141:375–80.

    Article  PubMed  Google Scholar 

  12. Capes SE, Hunt D, Malmberg K, et al. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001;32:2426–32.

    Article  CAS  PubMed  Google Scholar 

  13. Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87:978–82.

    Article  CAS  PubMed  Google Scholar 

  14. Furnary AP, Gao G, Grunkemeier GL, et al. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125:1007–21.

    Article  CAS  PubMed  Google Scholar 

  15. Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003;78:1471–8.

    Article  PubMed  Google Scholar 

  16. Whitcomb BW, Pradhan EK, Pittas AG, et al. Impact of admission hyperglycemia on hospital mortality in various intensive care unit populations. Crit Care Med. 2005;33:2772–7.

    Article  PubMed  Google Scholar 

  17. Kosiborod M, Rathore SS, Inzucchi SE, et al. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction implications for patients with and without recognized diabetes. Circulation. 2005;111:3078–86.

    Article  CAS  PubMed  Google Scholar 

  18. Svensson AM, McGuire DK, Abrahamsson P, et al. Association between hyper-and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events. Eur Heart J. 2005;26:1255–61.

    Article  PubMed  Google Scholar 

  19. McAlister FA, Majumdar AR, Blitz S, et al. The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia. Diabetes Care. 2005;28:810–5.

    Article  PubMed  Google Scholar 

  20. Baker EH, Janaway CJ, Philips BJ, et al. Hyperglycemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. Thorax. 2006;61:284–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Pomposelli JJ, Baxter 3rd JK, Babineau TJ, et al. Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. J Parenter Enteral Nutr. 1998;22:77–81.

    Article  CAS  Google Scholar 

  22. Norhammar A, Tenerz A, Nilsson G, et al. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet. 2002;359:2140–4.

    Article  CAS  PubMed  Google Scholar 

  23. Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol. 1995;26:57–65.

    Article  CAS  PubMed  Google Scholar 

  24. Malmberg K, Ryden L, Wedel H, et al. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J. 2005;26:650–61.

    Article  CAS  PubMed  Google Scholar 

  25. Cheung NW, Wong VW, McLean M. The hyperglycemia: intensive insulin infusion in infarction (HI-5) study. Diabetes Care. 2006;29:765–70.

    Article  CAS  PubMed  Google Scholar 

  26. Furnary AP, Zerr KJ, Grunkemeier GL, et al. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg. 1999;67:352–62.

    Article  CAS  PubMed  Google Scholar 

  27. Umpierrez G, Cardona S, Pasquel F, et al. Randomized controlled trial of intensive versus conservative glucose control in patients undergoing coronary artery bypass graft surgery: GLUCO-CABG trial. Diabetes Care. 2015;38:1665–72.

    Article  CAS  PubMed  Google Scholar 

  28. Gandhi GY, Nuttall GA, Abel MD, et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery. Ann Intern Med. 2007;146:233–43.

    Article  PubMed  Google Scholar 

  29. Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–67.

    Article  PubMed  Google Scholar 

  30. Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354:449–61.

    Article  PubMed  Google Scholar 

  31. Van den Berghe G, Wilmer A, Milants I, et al. Intensive insulin therapy in mixed medical/surgical intensive care units. Diabetes. 2006;55:3151–9.

    Article  PubMed  Google Scholar 

  32. Brunkhorst FM, Engel C, Bloos F. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125–39.

    Article  CAS  PubMed  Google Scholar 

  33. Preiser JC, Devos P, Ruiz-Santana S, et al. A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive Care Med. 2009;35(10):1738–48.

    Article  CAS  PubMed  Google Scholar 

  34. The NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97.

    Article  Google Scholar 

  35. The Nice-SUGAR Study Investigators. Hypoglycemia and risk of death in critically ill patients. N Engl J Med. 2012;367:1108–18.

    Article  Google Scholar 

  36. Queale WS, Seidler AJ, Brancati FL, et al. Glycemic control and sliding scale insulin use in medical inpatients with diabetes mellitus. Arch Intern Med. 1997;157:545–52.

    Article  CAS  PubMed  Google Scholar 

  37. Umpierrez GE, Smiley D, Zisman A, et al. Randomized study of basal bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care. 2007;30:2181–6.

    Article  CAS  PubMed  Google Scholar 

  38. Umpierrez GE, Mulligan P, Smiley D, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care. 2011;34:256–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Moghissi ES, Korytkowski MT, Di Nardo M, et al. American Association of Clinical Endocrinologists, American Diabetes Association. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009;32(6):1119–31.

    Google Scholar 

  40. Meigering S, Corstjens AM, Tulleken JE, et al. Towards a feasible algorithm for tight glycaemic control in critically ill patients: a systematic review of the literature. Crit Care. 2006;10(R19):1–7.

    Google Scholar 

  41. Goldberg PA, Siegel MD, Sherwin RS, et al. Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. Diabetes Care. 2004;27:461–7.

    Article  CAS  PubMed  Google Scholar 

  42. Goldberg PA, Roussel MG, Inzucchi SE. Clinical results of an updated insulin infusion protocol in critically ill patients. Diabetes Spectr. 2005;18:188–91.

    Article  Google Scholar 

  43. Schmeltz LR, DeSantis AJ, Schmidt K, et al. Conversion of intravenous insulin infusions to subcutaneously administered insulin glargine in patients with hyperglycemia. Endocr Pract. 2006;12:641–50.

    Article  PubMed  Google Scholar 

  44. ADA. Standards of medical care in diabetes. Diabetes Care. 2007;31:S12–54.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Endocrinology, Diabetes and Metabolism, Allegheny General Hospital, Cranberry Township, PA, USA

    Samantha DeMauro-Jablonski

  2. Section of Endocrinology, Yale University School of Medicine, Yale Diabetes Center, Yale-New Haven Hospital, New Haven, CT, USA

    Silvio E. Inzucchi

Authors
  1. Samantha DeMauro-Jablonski
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  2. Silvio E. Inzucchi
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Corresponding author

Correspondence to Samantha DeMauro-Jablonski .

Editor information

Editors and Affiliations

  1. Lenox Hill Hospital Division of Endocrinology, New York, New York, USA

    Leonid Poretsky

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© 2015 Springer International Publishing Switzerland

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DeMauro-Jablonski, S., Inzucchi, S.E. (2015). Management of Diabetes and Hyperglycemia in the Hospital Setting. In: Poretsky, L. (eds) Principles of Diabetes Mellitus. Springer, Cham. https://doi.org/10.1007/978-3-319-20797-1_47-1

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  • DOI: https://doi.org/10.1007/978-3-319-20797-1_47-1

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  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-20797-1

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