Management of diabetes and hyperglycemia in the hospital setting

Abstract

Diabetes mellitus and hyperglycemia are frequently encountered in hospitalized patients and present complex management problems. This issue will continue to stress the health-care system in the United States as an increase in the overall diabetes prevalence is anticipated over the coming decades.1 Since diabetic patients are hospitalized more often than their non-diabetic peers, hyperglycemia in the hospital will become an increasingly common scenario. Hospitalizations can relate directly to uncontrolled diabetes, such as diabetic ketoacidosis (DKA), hyperosmotic hyperglycemic syndrome (HHS), or severe hypoglycemia; or to the complications of diabetes including cardiac disease, stroke, foot infections, amputations, and kidney disease; or to the variety of general medical conditions to which the diabetic patient is predisposed (community acquired pneumonia, influenza, etc.). National hospital discharge data from 2004 estimate that 609,000 admissions to the hospital involved a primary diagnosis of diabetes, while 5.2 million admissions carried a non-diabetic principal diagnostic code (i.e., diabetes as a secondary diagnosis).2 Trends toward monitoring patients more closely in an outpatient setting, with adherence to new practice guidelines concerning glucose management, may potentially decrease hospitalization rates related to metabolic control. © 2010 Springer-Verlag US.