The perils of inpatient hyperglycemia management: How we turned apathy into action

Abstract

As the number of Americans with pre-diabetes and diabetes continues to grow, so too will the number of patients who come into the hospital with hyperglycemia. Although tight glycemic control has been a well-established goal in the outpatient setting, it has only recently gained heightened interest in the inpatient arena. There is a growing body of knowledge supporting the benefits of strict glycemic control in hospitalized patients, yet there is little or no formal didactic training for health care professionals in inpatient management of patients with diabetes. Despite wide-spread inpatient hypoglycemic and hyperglycemic events, there are few systems in place for effective diabetes care and management. In January 2006, the American Association of Clinical Endocrinologists, the American College of Endocrinology, and the American Diabetes Association convened a meeting titled "Improving Inpatient Diabetes Care: A Call to Action Consensus Development Conference," which concluded that facilitating these changes required a paradigm shift that involves modifying both individual and institutional beliefs and practices that have been status quo for decades. One of the key consensus recommendations was the formation of an interdisciplinary steering committee to identify deficits, develop strategies, and facilitate the implementation of interventions to improve inpatient care. This article illustrates the planning and implementation of a systems-wide model to conquer inpatient hyperglycemia in an academic medical center.