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© American Diabetes Association ®, Inc., 2004
Editorial |
Hyperglycemia in the Hospital: Changing the Way We Think
| The first 20% of the full text of this article appears below. |
A cardiac nurse, Jeanne Zerr, asked a question more than 10 years ago that has helped shape our current knowledge about hyperglycemia in the hospital setting. She wanted to know if high blood glucose levels were associated with increased thoracic wound infections. In 1997, Zerr and her colleagues in Portland, Ore., published an article with the findings that "the incidence of deep wound infection in diabetic patients was reduced after implementation of a protocol to maintain mean blood glucose levels < 200 mg/dl in the immediate postoperative care."1 Once the Portland group identified that hyperglycemia did affect wound healing, they developed a protocol to administer IV insulin to achieve tighter glucose control intraopertively and postoperatively.2 They have continued to study the impact of hyperglycemia on outcomes.
According to an article in the Wall Street Journal, nurses were initially resistant to the introduction of IV insulin protocols in the hospital.3 I would guess that nurses were not the only ones resistant to the use of IV insulin protocols in the operating room and postoperatively. It appears that in our hospitals, not only are nurses resistant, but also surgeons, anesthesiologists, and other diabetes specialists are not convinced that glucose control matters during hospitalizations.
It is time to change the way we think about hyperglycemia in the hospital.
Positive steps are being taken to disseminate the results of
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