Inpatient diabetes management in general medical and surgical settings: evidence and update

Abstract

A quarter of patients who are hospitalized for any reason have diabetes as a comorbid condition. Despite this, management of diabetes among inpatients has historically been a low clinical priority. Since the publication of several landmark trials demonstrating the benefits of intensive glycemic control in the surgical intensive care unit, inpatient glycemic control on general hospital wards has received increased attention. Physicians and healthcare organizations in the USA have recently advocated more aggressive treatment of inpatient hyperglycemia despite the lack of data to guide evidence-based management in general (non-intensive care unit) settings. These calls to action have prompted a series of studies that demonstrate effective systems-based strategies for measuring and improving inpatient glycemic control, even though it is not yet clear how aggressively this goal should be pursued. While the data on improved long-term outcomes related to improved glycemic control in general inpatient settings are sparse, at the very least, inpatient diabetes management is likely to be beneficial if it prevents extremes of hyper- and hypoglycemia, decreases medication error, and facilitates improved outpatient medication regimens and self-management skills, which, in turn, may lead to improved glycemic control after discharge.

Keywords::

• inpatient diabetes management
• intensive glycemic control
• tight glycemic control

Acknowledgement

The author would like to thank David M Nathan for comments on an earlier draft of this manuscript.

Financial & competing interests disclosure

This work is supported by the NIH, grant number K23 DK080228-01. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

*Based on consensus conference [47].