Management of hyperglycemia in hospitalized patients: Noncritical care setting

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Abstract

Hyperglycemia is a common in-hospital problem and is associated with poor clinical outcomes. A critical review of pertinent studies and peer-reviewed publications related to inpatient glycemia was conducted. Diabetes mellitus is a problem of worldwide proportion that leads to frequent hospitalization. Hyperglycemia is often found in inpatient settings and is associated with increased risk of morbidity and mortality, surgical interventions, in-hospital infections and surgical site infections, higher admission rates to intensive care units (ICUs), increased hospital length of stay, and increased postdischarge care needs. In some studies, improved inpatient glycemia showed a positive impact in clinical outcomes. Attainment of adequate glycemic control requires addressing various clinical scenarios. The approach to hyperglycemia should abide by the principles of provision of adequate insulin regimens that consider the individual clinical situation of patients and aim for safe glucose targets. The control of hyperglycemia in the nonintensive care setting is a relevant clinical problem that requires effective and prudent strategies. This chapter provides an overview of scenarios encountered in general medical and surgical units, offers a practical approach to management of dysglycemia, lists factors contributing to hyperglycemia and hypoglycemia, reviews the recommended targets for treatment, and presents a strategy for transition to outpatient care. The research evidence available suggests that hyperglycemia is associated with poor clinical outcomes in critically and noncritically ill patients. Additionally, tight glycemic control increases the risk for hypoglycemia and mortality, and less stringent glucose targets may result in lower rates of hypoglycemia. Therefore, judicious glucose control, as opposed to stringent near-normal control proposed in previous clinical guidelines and statements, is probably sufficient to prevent poor clinical outcomes related to hyperglycemia in the ICU. The data available in non-ICU settings is less robust; however, good glucose management remains important in hospitalized patients across clinical units and an attentive attitude toward care of inpatient hyperglycemia should prevail among providers.

Original languageEnglish (US)
Pages (from-to)31-46
Number of pages16
JournalFrontiers in Diabetes
Volume24
DOIs
Publication statusPublished - Jan 1 2015

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All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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