Hyperglycemia in the hospital setting: the case for improved control among non-diabetics.
OBJECTIVE
To review studies on the role of hyperglycemia in acutely ill adults, regardless of diabetes diagnosis, and the impact of glucose control on health outcomes.


METHODS
Searches on Ovid MEDLINE, Ovid Evidence-Based Medicine (EBM), and PubMed MEDLINE, limited to articles written in English, trials conducted on adult subjects, and material published between 1994 and April 2004. Search words included the major MeSH term hyperglycemia and title words glucose, hyperglycemia/hyperglycemic, or insulin therapy, with text words admission, hospitalized, in-hospital, or inpatient.


METHODS
All articles identified from the data sources were evaluated, and all information deemed relevant was included in this review.


RESULTS
Hyperglycemia, even in patients without diabetes, has been shown to be detrimental among inpatients in medical and surgical units, as well as in critical care. A review of 25 outcomes studies indicated that the majority of research on this topic used retrospective or prospective cohort designs; only 2 were conducted as randomized controlled studies. In general, the findings demonstrated negative impact on outcomes among various patient populations with hyperglycemia including increased lengths of stay, health complications, utilization of resources, and risk of mortality.


CONCLUSIONS
Studies report that hyperglycemia is a common but detrimental condition and that better control in the hospital setting decreases short- and long-term risk of mortality, illness complications, hospital lengths of stay, and healthcare costs. Increased efforts to treat hyperglycemia and screen for diabetes are needed in the hospital setting. Future studies on cost-effective approaches to glucose control are recommended.
Conner
Therese M
TM
Brain and Spine Center, Seton Healthcare Network, 601 E. 15th Street, Austin, TX 78701-1096, USA. tmconner@seton.org
Flesner-Gurley
Kelly R
KR
Barner
Jamie C
JC
D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D018836:Inflammation Mediators / Q000502:physiology; D007328:Insulin / Q000627:therapeutic use; D007902:Length of Stay / Q000191:economics; D009460:Neurologic Examination; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality
D007004:Hypoglycemic Agents; D018836:Inflammation Mediators; D007328:Insulin