Evaluation of hospital glycemic control at US academic medical centers.
OBJECTIVE
To evaluate contemporary hospital glycemic management in US academic medical centers.


METHODS
This retrospective cohort study was conducted on patients discharged from 37 academic medical centers between July 1 and September 30, 2004; 1,718 eligible adult patients met at least 1 of the inclusion criteria: 2 consecutive blood glucose readings >180 mg/dL within 24 hours, or insulin treatment at any time during hospitalization. We assessed 3 consecutive measurement days of glucose values, glycemic therapy, and additional clinical and laboratory characteristics.


RESULTS
In this diverse cohort, 79% of patients had a prior diagnosis of diabetes, and 84.6% received insulin on the second measurement day. There was wide variation in hospital performance of recommended hospital diabetes care measures such as glycosylated hemoglobin (A1C) assessment (range, 3%-63%) and timely admission laboratory glucose measurement (range, 39%-97%). Median glucose was significantly lower for patients in the intensive care unit (ICU) compared to ward/intermediate care. ICU patients treated with intravenous insulin had significantly lower median glucose when compared to subcutaneous insulin. Only 25% of ICU patients on day 3 had estimated 6 AM glucose <or=110 mg/dL. Hyperglycemia was common, 50% of all patients had >or=1 glucose measurement >or=180 mg/dL on measurement days 2 and 3. Severe hypoglycemia (<50 mg/dL) occurred in 2.8% of all patient days.


CONCLUSIONS
Despite frequent insulin use, glucose control was suboptimal. Academic medical centers have opportunities to improve care to meet current American Diabetes Association hospital diabetes care standards.
Boord
Jeffrey B
JB
Veterans Affairs Tennessee Valley Health Care System, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8802, USA. jeffrey.boord@vanderbilt.edu
Greevy
Robert A
RA
Braithwaite
Susan S
SS
Arnold
Pamela C
PC
Selig
Patricia M
PM
Brake
Helga
H
Cuny
Joanne
J
Baldwin
David
D
D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D038321:Glycemic Index / Q000187:drug effects* / Q000502:physiology; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy*; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States
D001786:Blood Glucose; D007328:Insulin