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diabetes management in the hospital

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Diabetes Management in the Hospital Thomas W. Donner, MD a,b, * , Kristin M. Flammer, MD a a Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, 22 S. Greene Street, Room N3W130, Baltimore, MD 21201, USA b Joslin Diabetes Center Affiliate, University of Maryland School of Medicine, 22 South Greene Street, Room N6W100, Baltimore, MD 21201, USA Diabetes is an increasingly prevalent disease, with 9.3% of adults 20 years or older in the United States now afflicted [1]. Patients with diabetes make up a disproportionate percentage of those admitted to the hospital, because of mor e fre quent hospi talizations for car dio vasc ular , cer ebr ovas cul ar, and peripheral vascular disease; renal failure; infections; and lower extremity am- putations. While landmark studies in the 1990s demonstrated reduced micro- and macrovascu lar events with aggre ssive diabetes cont rol in outp atien ts [2–5], only recently has evidence supported aggressive inpatient diabetes con- trol. Historically, inpatient hyperglycemia has been viewed as an expected outcome of a stressful illness among glucose-intolerant individuals. Physi- cians have traditionally delegated inpatient diabetes management as second- ary in importance to the acute illness, often instituting sliding scale insulin as the only means to addr ess hype rglycemia [6]. Ho wever, diabetes ha s no w been identified as an independent risk factor for adverse inpatient outcomes [7,8]. Ran domize d stu die s have also shown that aggres sive tre atment of hyperglyc e- mia in the intensi ve care unit set ting leads to redu ced morb idity and mortal ity [9–11]. This arti cl e wi ll re vi ew the adverse effects of hype rglyc emia among hos- pitalized patients, and provide treatment recommendations. Prevalence of diabetes and hyperglycemia Patients with diabetes are two to five times more likely to be hospitalized than patients without diabetes and many patients are undiagnosed before * Corresponding author. Division of Endocrinology, Diabetes and Nutrition, University of Mar yla nd School of Med ici ne, 22 S. Gre ene Street, Roo m N3W130, Baltimore , MD 21201. E-mail address: [email protected] (T.W. Donner). 0025-7125/08/$ - see front matter Ó 2008 Elsevier Inc. All rights reserved. Med Clin N Am 92 (2008) 407–425

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