Diabetes care in hospitalized noncritically ill patients: More evidence for clinical inertia and negative therapeutic momentum.
BACKGROUND
Little is known about management of hyperglycemia in inpatients.


OBJECTIVE
To gain insight into caring for hospitalized patients with hyperglycemia.


METHODS
Retrospective analysis.


METHODS
Teaching hospital.


METHODS
Data on all patients discharged between January 1, 2001, and December 31, 2004 with a diagnosis of diabetes or hyperglycemia were extracted and linked to laboratory and pharmacy databases. Only the data on patients who did not require intensive care and who were hospitalized for at least 3 days were analyzed.


METHODS
Average bedside glucose during the first and last 24 hours of hospital stay and for the entire length of stay; assessment of changes in insulin regimen and dose.


RESULTS
The average age of patients included in the study (n = 2916) was 69 years. Fifty-seven percent of the patients were men, 90% were white, and average length of stay was 5.7 days. More than 20% of the patients had evidence of sustained hyperglycemia. Forty-two percent of the patients who showed poor control of glycemia (glucose > 200 mg/dL) during the first 24 hours were discharged in poor control. The frequency of hypoglycemia was low (only 2.2 of 100 measurements per person) compared with hyperglycemia (25.5 of 100 measurements per person). Most patients (72%) received insulin during hospitalization, but there was high use of short-acting insulin and less than optimal intensification of therapy (clinical inertia); many patients had insulin therapy decreased despite persistent hyperglycemia (negative therapeutic momentum).


CONCLUSIONS
Glycemic control in the hospital was frequently poor, and there was suboptimal use of insulin, even among patients with sustained hyperglycemia. Educational programs directed at practitioners should focus on the importance of inpatient glucose control and provide guidelines on how and when to change therapy.
Cook
Curtiss B
CB
Division of Endocrinology, Mayo Clinic, Scottsdale, Arizona, USA.
Castro
Janna C
JC
Schmidt
Ronald E
RE
Gauthier
Susanne M
SM
Whitaker
Michael D
MD
Roust
Lori R
LR
Argueta
Rodolfo
R
Hull
Bryan P
BP
Zimmerman
Richard S
RS
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000097:blood* / Q000628:therapy; D019468:Disease Management; D005260:Female; D038321:Glycemic Index; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000628:therapy; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose; D007328:Insulin