No abstract

Currently patients with diabetes comprise up to 25–30% of the census of adult wards and critical care units in our hospitals. Although evidence suggests that avoidance of hyperglycemia (>180 mg/dL) and hypoglycemia (<70 mg/dL) is beneficial for positive outcomes in the hospitalized patient, much of this evidence remains controversial and at times somewhat contradictory. We have recently formed a consortium for Planning Research in Inpatient Diabetes (PRIDE) with the goal of promoting clinical research in the area of management of hyperglycemia and diabetes in the hospital. In this article, we outline eight aspects of inpatient glucose management in which randomized clinical trials are needed. We refer to four as system-based issues and four as patient-based issues. We urge further progress in the science of inpatient diabetes management. We hope this call to action is supported by the American Diabetes Association, The Endocrine Society, the American Association of Clinical Endocrinologists, the American Heart Association, the European Association for the Study of Diabetes, the International Diabetes Federation, and the Society of Hospital Medicine. Appropriate federal research funding in this area will help ensure high-quality investigations, the results of which will advance the field. Future clinical trials will allow practitioners to develop optimal approaches for the management of hyperglycemia in the hospitalized patient and lessen the economic and human burden of poor glycemic control and its associated complications and comorbidities in the inpatient setting.

Diabetes education programs can have long term benefits on knowledge, psychosocial functioning, and glycemic control for older diabetic patients. The addition of support groups enhances diabetes knowledge and psychosocial functioning.

Improvements in diabetes knowledge, psychosocial functioning, and metabolic control were assessed following a six-week diabetes education program for older male patients (aged 65 to 82 years) and their spouses. Before and after the program, scored questionnaires were administered to patients and their wives regarding knowledge, quality of life, stress, family involvement in diabetes care, and patient involvement in social activities. The patients were again assessed six months later. Results were compared to those of younger adult male patients (aged 28 to 64 years). The older patients significantly increased their knowledge of diabetes (P less than .05), and to an extent equal to that of younger individuals. Reduction in stress correlated with their increase in knowledge (r = 0.9; P less than .05) and their improved diet-related quality of life (r = 0.7; P less than .02). A decrease in stress was still evident six months after the program P less than .01). Perceived quality of life for areas requiring greater life-style modification (diet and exercise) increased (P less than .01), and was maintained at six months. In contrast, younger patients reported decreases in perceived quality of life (P less than .05). Older patients with participating spouses, compared to those without, showed greater improvement in knowledge (P less than .02), increase in family involvement (P less than .05), less stress (P less than .02), and improvement in metabolic control of diabetes (P less than .001). The program increased spouses' knowledge and perceived involvement in the care of their diabetic partners (P less than .01). This study suggests that diabetes education is an effective intervention for elderly patients and their spouses.(ABSTRACT TRUNCATED AT 250 WORDS)