Hospital Hypoglycemia: Not Only Treatment But Also Prevention

Braithwaite, Susan S.; Buie, Michelle M.; Thompson, Cara L.; Baldwin, Douglas F.; Oertel, Maryanne D.; Robertson, Beverly A.; Mehrotra, Hetal P.

doi:10.4158/ep.10.s2.89

Cited by 75 publications

(73 citation statements)

References 94 publications

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“…Increasing evidence from observational and prospective interventional studies has shown that inpatient hyperglycemia is a predictor of poor clinical outcome of adult subjects. [3][4][5][6][7][8][9][10][11][12][13]16,17 Admission hyperglycemia has been associated with increased morbidity and mortality in patients with critical illness, as well as in non-critically ill adult subjects admitted to general surgical and medical wards. 3,6,18 In this study we also found that hyperglycemia is a common finding in children admitted with critical and noncritical illnesses and that most children had no history of diabetes before admission.…”

Section: Discussionmentioning

confidence: 99%

“…Extensive evidence from observational studies indicates that hyperglycemia in patients with or without a history of diabetes is an important marker of poor clinical outcome. [3][4][5][6][7][8][9][10][11][12] Several prospective randomized trials in patients with critical illness have shown that aggressive glycemic control improves short-and long-term mortality, multiorgan failure and systemic infection, and length of hospitalization. [13][14][15][16][17] The importance of glucose control also applies to adult patients admitted to general surgical and medical wards.…”

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confidence: 99%

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Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Palacio

Smiley

Cerón

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:Inpatient hyperglycemia in adult patients with and without a history of diabetes is a predictor of poor clinical outcome. No previous studies, however, have examined the association of hyperglycemia and clinical outcome in children admitted to a community pediatric hospital.METHODS:The study was a retrospective observational cohort of pediatric patients admitted to a community children's hospital from January 2004 to August 2004. Medical records of 903 consecutive children admitted to critical and non–critical care areas were reviewed. Of them, 342 patients (38%) had no blood glucose measurements during their hospital stay. In the remaining patients, we determined the prevalence of hyperglycemia and examined the association of hyperglycemia with clinical outcome.RESULTS:A total of 406 patients (75%) had an admission blood glucose ≤120 mg/dL (mean ± SEM 98 ± 1 mg/dL), 103 children (19%) had an admission blood glucose level of 121–179 mg/dL (mean 143 ± 2 mg/dL), and 32 patients (5.9%) had a blood glucose level ≥180 mg/dL (mean 260 ± 18 mg/dL). Seventeen patients (13%) had a known history of diabetes prior to admission. Children with hyperglycemia were more likely to be admitted to the ICU (P < .001) and had a longer length of ICU stay (P < .001), but admission hyperglycemia was not associated with longer hospital stay or higher hospital mortality.CONCLUSIONS:Hyperglycemia is present in one‐fourth of children admitted to the hospital, most of them without a history of diabetes prior to admission. Hyperglycemia was associated with a greater need for ICU care and longer ICU stay but not with increased in‐hospital mortality. Journal of Hospital Medicine 2008;3:212–217. © 2008 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Palacio

Smiley

Cerón

et al. 2008

Journal of Hospital Medicine

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“…Because it has been recommended that a hypoglycemia and hyperglycemia prevention protocol as well as a hypoglycemia and hyperglycemia treatment protocol be in place, the HDTF will be focusing on the actual prevention of the hypoglycemic and hyperglycemic incidents occurring in the first place. 2,25 This may result in further reductions of hypoglycemic and hyperglycemic events. We have recently implemented hypoglycemia and hyperglycemia prevention policies at MUSC.…”

Section: Discussionmentioning

confidence: 99%

Impact of improvement efforts on glycemic control and hypoglycemia at a University Medical Center

Hermayer

Cawley

Arnold

et al. 2009

Journal of Hospital Medicine

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BACKGROUND:Great emphasis is placed on optimizing treatment of hospitalized patients with diabetes and hyperglycemia.OBJECTIVE:This study was conducted to determine if the application of hospital‐wide insulin order sets improved inpatient safety by reducing the number of actual hypoglycemic and hyperglycemic events and increasing at‐target blood glucose.DESIGN:A retrospective chart review was conducted of hypoglycemic and hyperglycemic events and at‐target blood glucose occurring before and after institution of the insulin order sets and blood glucose protocols.SETTING:The Medical University of South Carolina (MUSC) Medical Center is a 709‐bed hospital and tertiary referral center for partnering hospitals in the southeastern United States.PATIENTS:All patients were evaluated who had a documented history of diabetes or who had at least 1 finger‐stick blood glucose above 180 mg/dL who were admitted for care to the MUSC adult main hospital (minimum of 18 years‐of‐age; maximum 100 years‐of‐age) during June 2004, June 2005, June 2006, and June 2007.INTERVENTION:The intervention involved institution of hospital‐wide hypoglycemia, hyperglycemia, subcutaneous insulin, and intravenous insulin treatment protocols.MEASUREMENTS:Retrospective data on hypoglycemia, hyperglycemia, and at‐target blood glucose incidence and frequency were collected via a computerized repository for all inpatients.RESULTS:The percent time in range improved by 10% with no increase in the amount of severe hypoglycemic episodes for the blood glucose results.CONCLUSIONS:Implementing standardized insulin order sets including hypoglycemia and hyperglycemia treatment protocols at MUSC produced expected benefits for patient safety for this patient population. Journal of Hospital Medicine 2009;4:331–339. © 2009 Society of Hospital Medicine.

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“…The recent ADA technical review on inpatient diabetes used the term "programmed" or "scheduled insulin requirement" to refer to the dose requirement during hospitalization that is necessary to cover both basal and nutritional needs. 1,15 When patients are eating scheduled meals, basal and separate prandial insulin requirements provide good options.…”

Section: Scheduled Insulin Therapymentioning

confidence: 99%