title: Failure to control hyperglycemia in noncritically ill diabetes patients despite standard glycemic management in a hospital setting.
abstract: BACKGROUND
  Successful control of hyperglycemia has been shown to improve outcomes for diabetes patients in a clinical setting. We assessed the quality of physician-based glycemic management in two general wards, considering the most recent recommendations for glycemic control for noncritically ill patients (<140 mg/dl for premeal glucose).
  
  
  METHODS
  Quality of glycemic management of 50 patients in two wards (endocrinology, cardiology) was assessed retrospectively by analyzing blood glucose (BG) levels, the glycemic management effort, and the online questionnaire.
  
  
  RESULTS
  Glycemic control was clearly above the recommended target (mean BG levels: endocrinology: 175 ± 62 mg/dl; cardiology: 186 ± 68 mg/dl). When comparing the first half with the second half of the hospital stay, we found no difference in glycemic control (endocrinology: 168 ± 32 vs 164 ± 42 mg/dl, P = .67; cardiology: 174 ± 36 mg/dl vs 170 ± 42 mg/dl, P =.51) and in insulin dose (endocrinology: 15 ± 14 IU vs 15 ± 13 IU per day, P = .87; cardiology: 27 ± 17 IU vs 27 ± 18 IU per day, P = .92), despite frequent BG measurements (endocrinology: 2.7 per day; cardiology: 3.2 per day). A lack of clearly defined BG targets was indicated in the questionnaire.
  
  
  CONCLUSIONS
  The recommended BG target range was not achieved in both wards. Analysis of routine glycemic management demonstrated considerable glycemic management effort, but also a lack of translation into adequate insulin therapy. Implementation of corrective measures, such as structured treatment protocols, is essential.
authors.affiliation: Medical University of Graz, Department of Internal Medicine, Division Endocrinology and Metabolism, Graz, Austria.
authors.forename: Katharina Maria
authors.initials: KM
authors.lastname: Neubauer
authors.forename: Lukas
authors.initials: L
authors.lastname: Schaupp
authors.forename: Johannes
authors.initials: J
authors.lastname: Plank
authors.forename: Thomas
authors.initials: T
authors.lastname: Augustin
authors.forename: Selma Isabella
authors.initials: SI
authors.lastname: Mautner
authors.forename: Bernd
authors.initials: B
authors.lastname: Tschapeller
authors.forename: Thomas Rudolf
authors.initials: TR
authors.lastname: Pieber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000097:blood* / Q000453:epidemiology / Q000628:therapy*; D004704:Endocrinology / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods / Q000592:standards*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D059039:Standard of Care; D017211:Treatment Failure
chemical_list: D001786:Blood Glucose