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Published in: Current Diabetes Reports 1/2013

01-02-2013 | Hospital Management of Diabetes (G Umpierrez, Section Editor)

Glycemic Management in Medical and Surgical Patients in the Non-ICU Setting

Authors: Kara Hawkins, Amy C. Donihi, Mary T. Korytkowski

Published in: Current Diabetes Reports | Issue 1/2013

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Abstract

Hyperglycemia is commonly observed in hospitalized patients with and without previously known diabetes and is associated with adverse outcomes. For this reason, measurement of blood glucose (BG) is recommended for all patients at admission. Measurement of an A1C identifies patients with either newly recognized diabetes or uncontrolled diabetes. Current guidelines advise fasting and premeal BG <140 mg/dl, with maximal random BG <180 mg/dl for the majority of noncritically ill patients. Rational use of basal bolus insulin (BBI) regimens is effective in achieving these glycemic goals, with low risk for hypoglycemia. The safety of BBI relies upon provider knowledge for initiation and adjustment of insulin doses for changes in nutritional status or use of medications affecting glucose metabolism. Smooth transition of care to the outpatient setting is facilitated by providing oral and written instructions regarding timing and dosing of insulin, as well as education in basic skills for home management.
Literature
1.
go back to reference • Moghissi ES, Korytkowski MT, DiNardo MM, Einhorn D, Hellman R, Hirsch IB. American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control. Diabetes Care. 2009;32:1119–31. This review summarizes the evidence behind recommended glycemic targets for inpatient glycemic control in various settings as well as pointing out the need for future research for unanswered questions.PubMedCrossRef • Moghissi ES, Korytkowski MT, DiNardo MM, Einhorn D, Hellman R, Hirsch IB. American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control. Diabetes Care. 2009;32:1119–31. This review summarizes the evidence behind recommended glycemic targets for inpatient glycemic control in various settings as well as pointing out the need for future research for unanswered questions.PubMedCrossRef
2.
go back to reference • Reider J, Korytkowski MT. The adjectives of inpatient glycemic management. Curr Diab Rep. 2012;12:1–3. This essay addresses the controversy surrounding inpatient glycemic goals in the inpatient setting.PubMedCrossRef • Reider J, Korytkowski MT. The adjectives of inpatient glycemic management. Curr Diab Rep. 2012;12:1–3. This essay addresses the controversy surrounding inpatient glycemic goals in the inpatient setting.PubMedCrossRef
3.
go back to reference • Swanson CM, Potter DJ, Kongable GL, Cook CB. Update on inpatient glycemic control in hospitals in the United States. Endocr Pract. 2011;17:853–61. This article summarizes a large sampling of blood gluocse data in various types of U.S. hospitals and gives average rates of glycemic control, hyperglycemia and hypoglycemia.PubMedCrossRef • Swanson CM, Potter DJ, Kongable GL, Cook CB. Update on inpatient glycemic control in hospitals in the United States. Endocr Pract. 2011;17:853–61. This article summarizes a large sampling of blood gluocse data in various types of U.S. hospitals and gives average rates of glycemic control, hyperglycemia and hypoglycemia.PubMedCrossRef
4.
go back to reference Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27:553–91.PubMedCrossRef Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27:553–91.PubMedCrossRef
5.
go back to reference Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87:978–82.PubMedCrossRef Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87:978–82.PubMedCrossRef
6.
go back to reference •• Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012;97:16–38. This article summarizes and evaluates the level of evidence for multiple aspects of inpatient management of diabetes in non-critical care areas. Practical information is given for glycemic targets, insulin protocols and systems-based improvements in achieving glycemic control.PubMedCrossRef •• Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012;97:16–38. This article summarizes and evaluates the level of evidence for multiple aspects of inpatient management of diabetes in non-critical care areas. Practical information is given for glycemic targets, insulin protocols and systems-based improvements in achieving glycemic control.PubMedCrossRef
7.
go back to reference •• American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2012;35. This detailed presentation of the available literature on both inpatient and outpatient clinical diabetes care lays out the evidence behind best practices in comprehensive diabetes care for all populations of patients. •• American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2012;35. This detailed presentation of the available literature on both inpatient and outpatient clinical diabetes care lays out the evidence behind best practices in comprehensive diabetes care for all populations of patients.
8.
go back to reference •• Finfer S, Chittock DR, Su SY-S, Blair D, Foster D, Dhingra V, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97. This large multi-center trial demonstrated that tight glucose control increased mortality.PubMedCrossRef •• Finfer S, Chittock DR, Su SY-S, Blair D, Foster D, Dhingra V, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97. This large multi-center trial demonstrated that tight glucose control increased mortality.PubMedCrossRef
9.
go back to reference Inzucchi SE, Siegel MD. Glucose control in the ICU–how tight is too tight? N Engl J Med. 2009;360:1346–9.PubMedCrossRef Inzucchi SE, Siegel MD. Glucose control in the ICU–how tight is too tight? N Engl J Med. 2009;360:1346–9.PubMedCrossRef
10.
go back to reference Griesdale DEG, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. Can Med Assoc J. 2009;180:821–7.CrossRef Griesdale DEG, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. Can Med Assoc J. 2009;180:821–7.CrossRef
11.
go back to reference • Umpierrez GE, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P, et al. Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes Undergoing General Surgery (RABBIT 2 Surgery). Diabetes Care. 2011;34:256–61. This multicenter RCT showed that a weight-based basal-bolus insulin regimen improved glycemic control and reduced hospital complications compared with SSI in general surgery patients.PubMedCrossRef • Umpierrez GE, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P, et al. Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes Undergoing General Surgery (RABBIT 2 Surgery). Diabetes Care. 2011;34:256–61. This multicenter RCT showed that a weight-based basal-bolus insulin regimen improved glycemic control and reduced hospital complications compared with SSI in general surgery patients.PubMedCrossRef
12.
go back to reference • Noschese ML, DiNardo MM, Donihi AC, Gibson JM, Koerbel GL, Saul M, et al. Patient Outcomes After Implementation of a Protocol for Inpatient Insulin Pump Therapy. Endocr Pract. 2009;15:415–24. This article shows that most patients using CSII as outpatients can safely use them as inpatients as long as there is a hospital insulin pump protocol in place and hospital personnel familiar with its management.PubMedCrossRef • Noschese ML, DiNardo MM, Donihi AC, Gibson JM, Koerbel GL, Saul M, et al. Patient Outcomes After Implementation of a Protocol for Inpatient Insulin Pump Therapy. Endocr Pract. 2009;15:415–24. This article shows that most patients using CSII as outpatients can safely use them as inpatients as long as there is a hospital insulin pump protocol in place and hospital personnel familiar with its management.PubMedCrossRef
13.
go back to reference • Nassar AA, Partlow BJ, Boyle ME, Castro JC, Bourgeois PB, Cook CB. Outpatient-to-inpatient transition of insulin pump therapy: successes and continuing challenges. J Diabetes Sci Technol. 2010;4:863–72. This manuscript summarizes the hospital experience of 65 patients who used insulin pumps as inpatients in 125 hospitalizations.PubMed • Nassar AA, Partlow BJ, Boyle ME, Castro JC, Bourgeois PB, Cook CB. Outpatient-to-inpatient transition of insulin pump therapy: successes and continuing challenges. J Diabetes Sci Technol. 2010;4:863–72. This manuscript summarizes the hospital experience of 65 patients who used insulin pumps as inpatients in 125 hospitalizations.PubMed
14.
go back to reference van der Crabben SN, Blumer RME, Stegenga ME, Ackermans MT, Endert E, Tanck MWT, et al. Early endotoxemia increases peripheral and hepatic insulin sensitivity in healthy humans. J Clin Endocrinol Metab. 2009;94:463–8.PubMedCrossRef van der Crabben SN, Blumer RME, Stegenga ME, Ackermans MT, Endert E, Tanck MWT, et al. Early endotoxemia increases peripheral and hepatic insulin sensitivity in healthy humans. J Clin Endocrinol Metab. 2009;94:463–8.PubMedCrossRef
15.
go back to reference Akhtar S, Barash PG, Inzucchi SE. Scientific principles and clinical implications of perioperative glucose regulation and control. Anesth Analg. 2010;110:478–97.PubMedCrossRef Akhtar S, Barash PG, Inzucchi SE. Scientific principles and clinical implications of perioperative glucose regulation and control. Anesth Analg. 2010;110:478–97.PubMedCrossRef
16.
go back to reference • Deusenberry CM, Coley KC, Korytkowski MT, Donihi AC. Hypoglycemia in hospitalized patients treated with sulfonylureas. Pharmacotherapy. 2012;32:613–7. This nested case–control study identified the factors that increase the risk for sulfonylurea-related hypoglycemia in hospitalized patients. These risk factors include age ≥65 years, GFR ≤30 ml/minute/1.73 m2 , and concurrent use of intermediate- or long-acting insulin.PubMedCrossRef • Deusenberry CM, Coley KC, Korytkowski MT, Donihi AC. Hypoglycemia in hospitalized patients treated with sulfonylureas. Pharmacotherapy. 2012;32:613–7. This nested case–control study identified the factors that increase the risk for sulfonylurea-related hypoglycemia in hospitalized patients. These risk factors include age ≥65 years, GFR ≤30 ml/minute/1.73 m2 , and concurrent use of intermediate- or long-acting insulin.PubMedCrossRef
17.
go back to reference • Umpierrez GE, Smiley D, Zisman A, Prieto LM, Palacio A, Ceron M, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care. 2007;30:2181–6. This RCT showed that a weight-based basal-bolus insulin regimen improved glycemic control compared with SSI in noncritically ill hospitalized patients with type 2 diabetes.PubMedCrossRef • Umpierrez GE, Smiley D, Zisman A, Prieto LM, Palacio A, Ceron M, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care. 2007;30:2181–6. This RCT showed that a weight-based basal-bolus insulin regimen improved glycemic control compared with SSI in noncritically ill hospitalized patients with type 2 diabetes.PubMedCrossRef
18.
go back to reference • Umpierrez GE, Hor T, Smiley D, Temponi A, Umpierrez D, Ceron M, et al. Comparison of inpatient insulin regimens with detemir plus aspart versus neutral protamine hagedorn plus regular in medical patients with type 2 diabetes. J Clin Endocrinol Metab. 2009;94:564–9. This multicenter RCT in patients with type 2 diabetes demonstrated that treatment of hospitalized patients with basal-bolus regimen of detemir and aspart resulted in equivalent glycemic control and rates of hypoglycemia compared to a split-mixed regimen of NPH and regular insulin.PubMedCrossRef • Umpierrez GE, Hor T, Smiley D, Temponi A, Umpierrez D, Ceron M, et al. Comparison of inpatient insulin regimens with detemir plus aspart versus neutral protamine hagedorn plus regular in medical patients with type 2 diabetes. J Clin Endocrinol Metab. 2009;94:564–9. This multicenter RCT in patients with type 2 diabetes demonstrated that treatment of hospitalized patients with basal-bolus regimen of detemir and aspart resulted in equivalent glycemic control and rates of hypoglycemia compared to a split-mixed regimen of NPH and regular insulin.PubMedCrossRef
19.
go back to reference • Desimone ME, Blank GE, Virji M, Donihi A, DiNardo M, Simak DM, et al. Effect of an educational inpatient diabetes management program on medical resident knowledge and measures of glycemic control: A randomized controlled trial. Endocr Pract. 2012;18:238–43. This report summarizes the experience of using electronic and print materials that provide guidance for inpatient glycemic management among internal medicine residents.PubMedCrossRef • Desimone ME, Blank GE, Virji M, Donihi A, DiNardo M, Simak DM, et al. Effect of an educational inpatient diabetes management program on medical resident knowledge and measures of glycemic control: A randomized controlled trial. Endocr Pract. 2012;18:238–43. This report summarizes the experience of using electronic and print materials that provide guidance for inpatient glycemic management among internal medicine residents.PubMedCrossRef
20.
go back to reference Smith WD, Winterstein AG, Johns T, Rosenberg E, Sauer BC. Causes of hyperglycemia and hypoglycemia in adult inpatients. Am J Health Syst Pharm. 2005;62:714–9.PubMed Smith WD, Winterstein AG, Johns T, Rosenberg E, Sauer BC. Causes of hyperglycemia and hypoglycemia in adult inpatients. Am J Health Syst Pharm. 2005;62:714–9.PubMed
21.
go back to reference • Vaidya A, Hurwitz S, Yialamas M, Min L, Garg R. Improving the Management of Diabetes in Hospitalized Patients: The Results of a Computer-Based House Staff Training Program. Diabetes Technol Ther. 2012;14:610–8. This report summarizes the experience of a computer-based diabetes training program on comfort and knowledge of house staff relating to insulin administration practices.PubMedCrossRef • Vaidya A, Hurwitz S, Yialamas M, Min L, Garg R. Improving the Management of Diabetes in Hospitalized Patients: The Results of a Computer-Based House Staff Training Program. Diabetes Technol Ther. 2012;14:610–8. This report summarizes the experience of a computer-based diabetes training program on comfort and knowledge of house staff relating to insulin administration practices.PubMedCrossRef
22.
go back to reference • Donihi AC, Gibson JM, Noschese ML, DiNardo MM, Koerbel GL, Curll M, et al. Effect of a targeted glycemic management program on provider response to inpatient hyperglycemia. Endocr Pract. 2011;17:552–7. This study demonstrates the efficacy of a targeted program for reminding physicians of the need to modify therapy in patients who experience severe inpatient hyperglycemia.PubMedCrossRef • Donihi AC, Gibson JM, Noschese ML, DiNardo MM, Koerbel GL, Curll M, et al. Effect of a targeted glycemic management program on provider response to inpatient hyperglycemia. Endocr Pract. 2011;17:552–7. This study demonstrates the efficacy of a targeted program for reminding physicians of the need to modify therapy in patients who experience severe inpatient hyperglycemia.PubMedCrossRef
23.
go back to reference •• Baldwin D, Zander J, Munoz C, Raghu P, DeLange-Hudec S, Lee H, et al. A Randomized Trial of Two Weight-Based Doses of Insulin Glargine and Glulisin in Hospitalized Subjects With Type 2 Diabetes and Renal Insufficiency. Diabetes Care. 2012;35(10):1970–4. This study shows that a lower weight-based basal-bolus insulin dosing strategy for hospitalized patients with type 2 diabetes and chronic renal failure is as effective as and perhaps safer than standard weight-based dosing.PubMedCrossRef •• Baldwin D, Zander J, Munoz C, Raghu P, DeLange-Hudec S, Lee H, et al. A Randomized Trial of Two Weight-Based Doses of Insulin Glargine and Glulisin in Hospitalized Subjects With Type 2 Diabetes and Renal Insufficiency. Diabetes Care. 2012;35(10):1970–4. This study shows that a lower weight-based basal-bolus insulin dosing strategy for hospitalized patients with type 2 diabetes and chronic renal failure is as effective as and perhaps safer than standard weight-based dosing.PubMedCrossRef
24.
go back to reference • Ampudia-Blasco FJ, Rossetti P, Ascaso JF. Basal plus basal-bolus approach in type 2 diabetes. Diabetes Technol Ther. 2011;13 Suppl 1:S75–83. This review addresses an approach to initiation and modification of basal insulin therapy in the hospital setting.PubMed • Ampudia-Blasco FJ, Rossetti P, Ascaso JF. Basal plus basal-bolus approach in type 2 diabetes. Diabetes Technol Ther. 2011;13 Suppl 1:S75–83. This review addresses an approach to initiation and modification of basal insulin therapy in the hospital setting.PubMed
25.
go back to reference • Meyer C, Boron A, Plummer E, Voltchenok M, Vedda R. Glulisine versus human regular insulin in combination with glargine in noncritically ill hospitalized patients with type 2 diabetes: a randomized double-blind study. Diabetes Care. 2010;33:2496–501. This study compares the use of a rapid acting analog with regular insulin for the bolus component of a basal bolus insulin regimen in hospitalized patients.PubMedCrossRef • Meyer C, Boron A, Plummer E, Voltchenok M, Vedda R. Glulisine versus human regular insulin in combination with glargine in noncritically ill hospitalized patients with type 2 diabetes: a randomized double-blind study. Diabetes Care. 2010;33:2496–501. This study compares the use of a rapid acting analog with regular insulin for the bolus component of a basal bolus insulin regimen in hospitalized patients.PubMedCrossRef
26.
go back to reference • Smiley D, Rhee M, Peng L, Roediger L, Mulligan P, Satterwhite L, et al. Safety and efficacy of continuous insulin infusion in noncritical care settings. J Hosp Med. 2010;5:212–7. This report describes the efficacy and safety of the uses of continuous intravenous insulin infusions for glycemic management of patients in non-critical care areas.PubMedCrossRef • Smiley D, Rhee M, Peng L, Roediger L, Mulligan P, Satterwhite L, et al. Safety and efficacy of continuous insulin infusion in noncritical care settings. J Hosp Med. 2010;5:212–7. This report describes the efficacy and safety of the uses of continuous intravenous insulin infusions for glycemic management of patients in non-critical care areas.PubMedCrossRef
27.
go back to reference Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354:449–61.PubMedCrossRef Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354:449–61.PubMedCrossRef
28.
go back to reference Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125–39.PubMedCrossRef Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125–39.PubMedCrossRef
29.
go back to reference Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial. Ann Intern Med. 2007;146:233–43.PubMed Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial. Ann Intern Med. 2007;146:233–43.PubMed
30.
go back to reference • DiNardo M, Donihi AC, Forte P, Gieraltowski L, Korytkowski M. Standardized glycemic management and perioperative glycemic outcomes in patients with diabetes mellitus who undergo same-day surgery. Endocr Pract. 2011;17:404. This quality improvement initiative describes the efficacy and safety of preoperative instructions for insulin adjustments in patients admitted to a Same Day Surgery unit, as well as the efficacy of a perioperative glycemic management program for patients who are admitted with BG > 200 mg/dl.PubMedCrossRef • DiNardo M, Donihi AC, Forte P, Gieraltowski L, Korytkowski M. Standardized glycemic management and perioperative glycemic outcomes in patients with diabetes mellitus who undergo same-day surgery. Endocr Pract. 2011;17:404. This quality improvement initiative describes the efficacy and safety of preoperative instructions for insulin adjustments in patients admitted to a Same Day Surgery unit, as well as the efficacy of a perioperative glycemic management program for patients who are admitted with BG > 200 mg/dl.PubMedCrossRef
31.
go back to reference • Boyle ME, Seifert KM, Beer KA, Apsey HA, Nassar AA, Littman SD, et al. Guidelines for application of continuous subcutaneous insulin infusion (insulin pump) therapy in the perioperative period. J Diabetes Sci Technol. 2012;6:184–90. This report emphasizes the importance of standardizing the care of patients who use insulin pump therapy who are admitted for surgical procedures.PubMed • Boyle ME, Seifert KM, Beer KA, Apsey HA, Nassar AA, Littman SD, et al. Guidelines for application of continuous subcutaneous insulin infusion (insulin pump) therapy in the perioperative period. J Diabetes Sci Technol. 2012;6:184–90. This report emphasizes the importance of standardizing the care of patients who use insulin pump therapy who are admitted for surgical procedures.PubMed
32.
go back to reference • Nassar AA, Boyle ME, Seifert KM, Beer KA, Apsey HA, Schlinkert RT, et al. Insulin pump therapy in patients with diabetes undergoing surgery. Endocr Pract. 2012;18:49–55. This is another report emphasizing the importance of standardizing the care of patients who use insulin pump therapy who are admitted for surgical procedures.PubMedCrossRef • Nassar AA, Boyle ME, Seifert KM, Beer KA, Apsey HA, Schlinkert RT, et al. Insulin pump therapy in patients with diabetes undergoing surgery. Endocr Pract. 2012;18:49–55. This is another report emphasizing the importance of standardizing the care of patients who use insulin pump therapy who are admitted for surgical procedures.PubMedCrossRef
33.
go back to reference • Hellman R. Glucose meter inaccuracy and the impact on the care of patients. Diabetes Metab Res Rev. 2012;28:207–9. This essay summarizes the pitfalls that can occur with inpatient use of currently available glucose meters.PubMedCrossRef • Hellman R. Glucose meter inaccuracy and the impact on the care of patients. Diabetes Metab Res Rev. 2012;28:207–9. This essay summarizes the pitfalls that can occur with inpatient use of currently available glucose meters.PubMedCrossRef
34.
go back to reference • Olansky L, Kennedy L. Finger-stick glucose monitoring: issues of accuracy and specificity. Diabetes Care. 2010;33:948–9. This report summarized problems encountered with inpatient use of glucose meters using GDH-PQQ strips.PubMedCrossRef • Olansky L, Kennedy L. Finger-stick glucose monitoring: issues of accuracy and specificity. Diabetes Care. 2010;33:948–9. This report summarized problems encountered with inpatient use of glucose meters using GDH-PQQ strips.PubMedCrossRef
35.
go back to reference Desachy A, Vuagnat AC, Ghazali AD, Baudin OT, Longuet OH, Calvat SN, et al. Accuracy of bedside glucometry in critically ill patients: influence of clinical characteristics and perfusion index. Mayo Clin Proc. 2008;83:400–5.PubMedCrossRef Desachy A, Vuagnat AC, Ghazali AD, Baudin OT, Longuet OH, Calvat SN, et al. Accuracy of bedside glucometry in critically ill patients: influence of clinical characteristics and perfusion index. Mayo Clin Proc. 2008;83:400–5.PubMedCrossRef
36.
go back to reference • Frias JP, Lim CG, Ellison JM, Montandon CM. Review of adverse events associated with false glucose readings measured by GDH-PQQ-based glucose test strips in the presence of interfering sugars. Diabetes Care. 2010;33:728–9. This report summarizes adverse events associated with use of glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) test strips, demonstrating that the possibility of harm is not merely theoretical.PubMedCrossRef • Frias JP, Lim CG, Ellison JM, Montandon CM. Review of adverse events associated with false glucose readings measured by GDH-PQQ-based glucose test strips in the presence of interfering sugars. Diabetes Care. 2010;33:728–9. This report summarizes adverse events associated with use of glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) test strips, demonstrating that the possibility of harm is not merely theoretical.PubMedCrossRef
37.
go back to reference Mann EA, Mora AG, Pidcoke HF, Wolf SE, Wade CE. Glycemic control in the burn intensive care unit: focus on the role of anemia in glucose measurement. J Diabetes Sci Technol. 2009;3:1319–29.PubMed Mann EA, Mora AG, Pidcoke HF, Wolf SE, Wade CE. Glycemic control in the burn intensive care unit: focus on the role of anemia in glucose measurement. J Diabetes Sci Technol. 2009;3:1319–29.PubMed
38.
go back to reference • Pidcoke HF, Wade CE, Mann EA, Salinas J, Cohee BM, Holcomb JB, et al. Anemia causes hypoglycemia in intensive care unit patients due to error in single-channel glucometers: methods of reducing patient risk. Crit Care Med. 2010;38:471–6. This report introduces a mathematical formula for correcting erroneous POC BG values that occur in the setting of anemia in critically ill patients.PubMedCrossRef • Pidcoke HF, Wade CE, Mann EA, Salinas J, Cohee BM, Holcomb JB, et al. Anemia causes hypoglycemia in intensive care unit patients due to error in single-channel glucometers: methods of reducing patient risk. Crit Care Med. 2010;38:471–6. This report introduces a mathematical formula for correcting erroneous POC BG values that occur in the setting of anemia in critically ill patients.PubMedCrossRef
39.
go back to reference • Guerra YS, Lacuesta EA, Yrastorza R, Miernik J, Shakya N, Fogelfeld L. Insulin injections in relation to meals in the hospital medicine ward: comparison of 2 protocols. Endocr Pract. 2011;17:737–46. This randomized controlled trial found that rapid-acting insulin analogs are preferred over regular insulin for hospitalized patients requiring mealtime insulin.PubMedCrossRef • Guerra YS, Lacuesta EA, Yrastorza R, Miernik J, Shakya N, Fogelfeld L. Insulin injections in relation to meals in the hospital medicine ward: comparison of 2 protocols. Endocr Pract. 2011;17:737–46. This randomized controlled trial found that rapid-acting insulin analogs are preferred over regular insulin for hospitalized patients requiring mealtime insulin.PubMedCrossRef
40.
go back to reference • Donihi AC, Abriola C, Hall R, Korytkowski MT. Getting the Timing Right in the Hospital: Synching Insulin Administration with Meal Tray Arrival. Diabetes. 2010;59(Suppl 1), 1028-P Orlando,FL. This abstract summarizes the results of an observational study investigating the timing of insulin injections with meal delivery in a non-critically ill patient population. • Donihi AC, Abriola C, Hall R, Korytkowski MT. Getting the Timing Right in the Hospital: Synching Insulin Administration with Meal Tray Arrival. Diabetes. 2010;59(Suppl 1), 1028-P Orlando,FL. This abstract summarizes the results of an observational study investigating the timing of insulin injections with meal delivery in a non-critically ill patient population.
41.
go back to reference • Curll M, DiNardo M, Noschese M, Korytkowski MT. Menu selection, glycaemic control, and satisfaction with standard and patient-controlled consistent carbohydrate diet meal plans in hospitalised patients with diabetes. Qual Saf Health Care. 2010;19:355. This quality improvement initiative compared glycemic outcomes among similar groups of patients who received consistent carbohydrate or liberalized diets in the inpatient setting.PubMedCrossRef • Curll M, DiNardo M, Noschese M, Korytkowski MT. Menu selection, glycaemic control, and satisfaction with standard and patient-controlled consistent carbohydrate diet meal plans in hospitalised patients with diabetes. Qual Saf Health Care. 2010;19:355. This quality improvement initiative compared glycemic outcomes among similar groups of patients who received consistent carbohydrate or liberalized diets in the inpatient setting.PubMedCrossRef
42.
go back to reference Korytkowski MT, Salata RJ, Koerbel GL, Selzer F, Karslioglu E, Idriss AM, et al. Insulin therapy and glycemic control in hospitalized patients with diabetes during enteral nutrition therapy: a randomized controlled clinical trial. Diabetes Care. 2009;32:594–6.PubMedCrossRef Korytkowski MT, Salata RJ, Koerbel GL, Selzer F, Karslioglu E, Idriss AM, et al. Insulin therapy and glycemic control in hospitalized patients with diabetes during enteral nutrition therapy: a randomized controlled clinical trial. Diabetes Care. 2009;32:594–6.PubMedCrossRef
43.
go back to reference • Hermayer K, Smiley D, Olson DE, Khan AN, C., Fonseca V, Jacobs S, et al. Hospital discharge algorithm based on admission hBA1C for the management of patients with type 2 diabetes. Diabetes. 2012;61(Suppl 1):A–3. Philadelphia PA. This abstract presents 4 and 12 week A1C data among patients who were discharged from the hospital with intensification of their diabetes regimen for A1C >8%. • Hermayer K, Smiley D, Olson DE, Khan AN, C., Fonseca V, Jacobs S, et al. Hospital discharge algorithm based on admission hBA1C for the management of patients with type 2 diabetes. Diabetes. 2012;61(Suppl 1):A–3. Philadelphia PA. This abstract presents 4 and 12 week A1C data among patients who were discharged from the hospital with intensification of their diabetes regimen for A1C >8%.
44.
go back to reference Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med. 2007;2:314–23.PubMedCrossRef Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med. 2007;2:314–23.PubMedCrossRef
45.
go back to reference • Kimmel B, Sullivan MM, Rushakoff RJ. Survey on transition from inpatient to outpatient for patients on insulin: what really goes on at home? Endocr Pract. 2010;16:785–91. This study investigates patient responses to a questionnaire regarding knowledge of insulin therapy following hospital discharge. Patients treated with glucocorticoid therapy were not provided with adequate instructions regarding modification of insulin doses over time.PubMedCrossRef • Kimmel B, Sullivan MM, Rushakoff RJ. Survey on transition from inpatient to outpatient for patients on insulin: what really goes on at home? Endocr Pract. 2010;16:785–91. This study investigates patient responses to a questionnaire regarding knowledge of insulin therapy following hospital discharge. Patients treated with glucocorticoid therapy were not provided with adequate instructions regarding modification of insulin doses over time.PubMedCrossRef
46.
go back to reference Donihi AC, Yang E, Mark SM, Sirio C, Weber R. Scheduling of Pharmacist-Provided Medication Education for Hospitalized Patients. Hosp Pharm. 2008;43:121–6.CrossRef Donihi AC, Yang E, Mark SM, Sirio C, Weber R. Scheduling of Pharmacist-Provided Medication Education for Hospitalized Patients. Hosp Pharm. 2008;43:121–6.CrossRef
47.
go back to reference •• Seley JJ, D'Hondt N, Longo R, Manchester C, McKnight K, Rogers S, et al. AADE Position Statement: Diabetes inpatient management. Diabetes Educ. 2012;38:142–6. This AADE Position Statement outlines the role of the diabetes educator in the acute care setting.CrossRef •• Seley JJ, D'Hondt N, Longo R, Manchester C, McKnight K, Rogers S, et al. AADE Position Statement: Diabetes inpatient management. Diabetes Educ. 2012;38:142–6. This AADE Position Statement outlines the role of the diabetes educator in the acute care setting.CrossRef
48.
go back to reference Cook CB, Seifert KM, Hull BP, Hovan MJ, Charles JC, Miller-Cage V, et al. Inpatient to outpatient transfer of diabetes care: planing for an effective hospital discharge. Endocr Pract. 2009;15:263–9.PubMed Cook CB, Seifert KM, Hull BP, Hovan MJ, Charles JC, Miller-Cage V, et al. Inpatient to outpatient transfer of diabetes care: planing for an effective hospital discharge. Endocr Pract. 2009;15:263–9.PubMed
49.
go back to reference Robbins JM, Thatcher GE, Webb DA, Valdmanis VG. Nutritionist visits, diabetes classes, and hospitalization rates and charges: the Urban Diabetes Study. Diabetes Care. 2008;31:655–60.PubMedCrossRef Robbins JM, Thatcher GE, Webb DA, Valdmanis VG. Nutritionist visits, diabetes classes, and hospitalization rates and charges: the Urban Diabetes Study. Diabetes Care. 2008;31:655–60.PubMedCrossRef
Metadata
Title
Glycemic Management in Medical and Surgical Patients in the Non-ICU Setting
Authors
Kara Hawkins
Amy C. Donihi
Mary T. Korytkowski
Publication date
01-02-2013
Publisher
Current Science Inc.
Published in
Current Diabetes Reports / Issue 1/2013
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-012-0340-1

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Progression of β-Cell Dysfunction in Obese Youth

Hospital Management of Diabetes (G Umpierrez, Section Editor)

Adult Hyperglycemic Crisis: A Review and Perspective

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