Glucose control in acutely ill patients: a survey of Israeli internal medicine departments.
BACKGROUND
Tight glucose control has been shown to improve the outcome of patients with severe acute illnesses who are hospitalized in intensive care units and on intravenous insulin-based regimens.


OBJECTIVE
To clarify the attitudes of internists towards tight control of glucose levels in acutely ill patients hospitalized in general medical wards.


METHODS
A questionnaire on intensive glucose control in acutely ill patients hospitalized in medical wards was mailed to each of the 100 heads of internal medicine departments in Israel.


RESULTS
Fifty physicians responded. Of these, 80% considered tight glucose control to be a major treatment target, but only two-thirds had defined it as a goal in their ward. Furthermore, only about half had a defined protocol for such an intervention. Most physicians considered patients with acute coronary syndrome, stroke and infectious diseases as candidates for a tight glucose control protocol. The most frequently used modalities were multiple blood glucose measurements and repeated injections of short-acting subcutaneous insulin. The main reasons given for not having a defined protocol were lack of guidelines, no evidence of a clear benefit during hospitalization on a medical ward, and a shortage of adequately trained staff.


CONCLUSIONS
Inconsistencies in physicians' attitudes and in treatment protocols regarding tight control of glucose levels in acutely ill patients hospitalized on a medical ward need to be addressed. Evaluation of the feasibility, effectiveness and side effects of a defined protocol is needed before any regimen can be approved by the heads of the internal medicine departments.
Elis
Avishay
A
Department of Medicine, Sapir Medical Center, Kfar Saba, Israel. avishayel@clalit.org.il
Shacham-Abulafia
Adi
A
Lishner
Michael
M
D000208:Acute Disease; D001291:Attitude of Health Personnel; D001786:Blood Glucose / Q000378:metabolism; D044882:Glucose Metabolism Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006760:Hospitalization; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D007388:Internal Medicine; D007557:Israel; D010362:Patients' Rooms; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin