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Glucose Control in a Hospitalized Person With Diabetes

The first 300 words of the full text of this article appear below.

	Introduction

 
Hyperglycemia in hospitalized people with diabetes contributes to increased mortality and morbidity by increasing the susceptibility to infection and lengthening hospital stays. The underlying causes of hyperglycemia range from decompensated diabetes with metabolic changes associated with stress and illness to alterations in medications or therapeutic interventions that increase glucose levels.

No matter what the cause, hyperglycemia in the hospital setting has not been treated in the aggressive manner seen in the outpatient setting. Fear of hypoglycemia and its ability to trigger life-threatening complications such as cardiac arrhythmias contributes to the reluctance to set target goals < 200 mg/dl for inpatient glycemic management.

With the recent American Diabetes Association (ADA) publication of the technical review "Management of Diabetes and Hyperglycemia in Hospitals,"¹ the importance of glucose control in achieving positive outcomes in hospitalized patients has been underscored. Aggressive glucose goals aimed at reducing hyperglycemia and its negative effects on recovery are identified and supported by research such as the DIGAMI study.² A review of published studies indicates that elevated glucose levels increase post-surgical infection rates, reduce the ability to heal, contribute to increased cardiac morbidity and mortality, increase intensive care unit admissions, and increase lengths of stay.

The following case study illustrates the pitfalls in diabetes care frequently seen in hospitalized patients and identifies ways in which hospital management must change to achieve positive outcomes. The need for aggressive treatment of hyperglycemia and the importance of diabetes education within this setting is addressed.

	Case Presentation

 
J.M. is a 69-year-old man who presents to the emergency room (ER) with fever, shortness of breath, and persistent cough for 4 days. Based on his chest X-ray findings, co-morbidities, age, and medical history, he has been admitted to the hospital with the diagnosis of community-acquired pneumonia.

He has had type 2 diabetes for 8 years, and his . . . [Full Text of this Article]

Course of Treatment

	Discussion

 

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