title: The economics of glycemic control in the ICU in the United States.
abstract: OBJECTIVE
  Currently the USA has an aging population, with increasing deficits and a healthcare system that most would agree is in need of repair. Finding ways to curtail costs is urgently needed. Attention to glycemic control and metabolic care offers a cost-effective method of treatment to reduce complications.
  
  
  RESULTS
  Healthcare-related expenses occupy an expanding portion of gross domestic product in the US and are a driver of the deficit. Despite all of this spending, the US receives average marks on outcomes and is not obtaining value in its healthcare. Any movements toward healthcare reform must focus on improving outcomes per healthcare dollar spent, and increasing value. The Affordable Care Act will place greater emphasis on preventing complications and reducing hospital-acquired infections. The original Leuven trial demonstrated that proper implementation of glycemic control can reduce morbidity and mortality. More recent studies have shown that there is a cost-benefit to glycemic control as well, through reduction of hospital stay and prevention of complications. On the basis of these changes, physicians who practice metabolic care and provide glycemic control are well positioned to add value in this era of healthcare reform.
  
  
  CONCLUSIONS
  Glycemic control is inherently valuable in the care of ICU patients as it decreases infectious complications, reduces lengths of stay, and has a positive effect on morbidity and mortality. Further studies should be completed to delineate the exact amount of cost-savings that can be obtained by proper implementation of glycemic control in the ICU.
authors.affiliation: Department of Anesthesiology, Division of Critical Care, Cardiothoracic Intensive Care Unit, Mount Sinai School of Medicine, New York, New York, USA. Corey.Scurlock@mountsinai.org
authors.forename: Corey
authors.initials: C
authors.lastname: Scurlock
authors.forename: Jayashree
authors.initials: J
authors.lastname: Raikhelkar
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mechanick
mesh_terms: D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000379:methods; D019317:Evidence-Based Medicine; D017048:Health Care Costs; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin