Abstract
The epidemic of diabetes and results from several recent trials demonstrating the benefits of intensive glycemic control in the ICU setting have focused attention on inpatient glycemic control on general hospital wards, where over 25% of patients have diabetes. Current management of inpatient glycemia is haphazard, relying on corrective doses of insulin after hyperglycemia has occurred (the insulin “sliding scale”). Although data to guide evidence-based management of inpatient glycemia in non-critically ill patients are scant, the American College of Endocrinology and the American Diabetes Association have advocated more intensive therapy in the general inpatient setting, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has followed suit, launching an initiative on inpatient glycemic control. Extrapolation from basic and clinical studies suggests that improved diabetes management in general medical settings is likely to be beneficial, though the appropriate intensity of glycemic control in non-ICU settings has yet to be determined. Independent of the acute impact of inpatient glycemia, inpatient diabetes management is also important because hospitalization offers an opportunity to optimize care upon discharge for patients with poorly controlled diabetes. Finally, systems-level strategies likely to improve inpatient diabetes management are reviewed.
Keywords: DIGAMI trial, glycemic control, Acute hospitalization, hypoglycemia, corticosteroid
Current Diabetes Reviews
Title: Inpatient Diabetes Management in Non-ICU Settings: Evidence and Strategies
Volume: 3 Issue: 4
Author(s): Deborah J. Wexler and Enrico Cagliero
Affiliation:
Keywords: DIGAMI trial, glycemic control, Acute hospitalization, hypoglycemia, corticosteroid
Abstract: The epidemic of diabetes and results from several recent trials demonstrating the benefits of intensive glycemic control in the ICU setting have focused attention on inpatient glycemic control on general hospital wards, where over 25% of patients have diabetes. Current management of inpatient glycemia is haphazard, relying on corrective doses of insulin after hyperglycemia has occurred (the insulin “sliding scale”). Although data to guide evidence-based management of inpatient glycemia in non-critically ill patients are scant, the American College of Endocrinology and the American Diabetes Association have advocated more intensive therapy in the general inpatient setting, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has followed suit, launching an initiative on inpatient glycemic control. Extrapolation from basic and clinical studies suggests that improved diabetes management in general medical settings is likely to be beneficial, though the appropriate intensity of glycemic control in non-ICU settings has yet to be determined. Independent of the acute impact of inpatient glycemia, inpatient diabetes management is also important because hospitalization offers an opportunity to optimize care upon discharge for patients with poorly controlled diabetes. Finally, systems-level strategies likely to improve inpatient diabetes management are reviewed.
Export Options
About this article
Cite this article as:
Wexler J. Deborah and Cagliero Enrico, Inpatient Diabetes Management in Non-ICU Settings: Evidence and Strategies, Current Diabetes Reviews 2007; 3 (4) . https://dx.doi.org/10.2174/1573399810703040239
DOI https://dx.doi.org/10.2174/1573399810703040239 |
Print ISSN 1573-3998 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6417 |
![](/images/wayfinder.jpg)
- Author Guidelines
- Bentham Author Support Services (BASS)
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Dual Inhibition of DPP-4 and Cholinesterase Enzymes by the Phytoconstituents of the Ethanolic Extract of Prosopis cineraria Pods: Therapeutic Implications for the Treatment of Diabetes-associated Neurological Impairments
Current Alzheimer Research Development of Mobile Tracking System for Diabetes and Recent Patents on Diabetes Mellitus
Recent Patents on Engineering Resveratrol as a Potential Therapeutic Candidate for the Treatment and Management of Alzheimer's Disease
Current Topics in Medicinal Chemistry Bridging the Gap: The Potential Role of Corticosteroid Binding Globulin in Cardiac Steroid Facilitation
Current Drug Targets Social Media for Diabetes Health Education - Inclusive or Exclusive?
Current Diabetes Reviews Brain: The Potential Diagnostic and Therapeutic Target for Glaucoma
CNS & Neurological Disorders - Drug Targets Dyslipidemia, Vascular Atheroma and Statins
Current Vascular Pharmacology Osteoporosis Entwined with Cardiovascular Disease: The Implication of Osteoprotegerin and the Example of Statins
Current Medicinal Chemistry Cryptogenic Liver Diseases: Sailing by Sight from HIV Co-Infection with Hepatitis Viruses to HIV Mono-Infection Through the Pillars of Hercules
Current HIV Research Lipotoxicity on the Basis of Metabolic Syndrome and Lipodystrophy in HIV-1-Infected Patients Under Antiretroviral Treatment
Current Pharmaceutical Design Nicotinamide Phosphoribosyltransferase as a Target in Inflammation- Related Disorders
Current Topics in Medicinal Chemistry Mood Charting and Technology: New Approach to Monitoring Patients with Mood Disorders
Current Psychiatry Reviews The Gut-Brain Axis, Including the Microbiome, Leaky Gut and Bacterial Translocation: Mechanisms and Pathophysiological Role in Alzheimer’s Disease
Current Pharmaceutical Design Mesenchymal Stem Cells of Dental Origin-Their Potential for Antiinflammatory and Regenerative Actions in Brain and Gut Damage
Current Neuropharmacology Vascular, Oxidative, and Synaptosomal Abnormalities During Aging and the Progression of Type 2 Diabetes
Current Neurovascular Research Antiobesity Carbonic Anhydrase Inhibitors
Current Topics in Medicinal Chemistry Epigenetic control of cardiovascular health by nutritional polyphenols involves multiple chromatin-modifying writer-reader-eraser proteins
Current Topics in Medicinal Chemistry Recent Research Progress in Natural Bioactive Constituents against Lipid Metabolic Diseases
Current Topics in Medicinal Chemistry Control of Mycobacterium tuberculosis Infection by Glutathione
Recent Patents on Anti-Infective Drug Discovery Prolylcarboxypeptidase Gene Expression in the Heart and Kidney: Effects of Obesity and Diabetes
Cardiovascular & Hematological Agents in Medicinal Chemistry