Prevalence of Hyper- and Hypoglycemia Among Inpatients With Diabetes

Wexler, Deborah J.; Meigs, James B.; Cagliero, Enrico; Nathan, David M.; Grant, Richard W.

doi:10.2337/dc06-1715

Cited by 166 publications

(109 citation statements)

References 23 publications

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“…This was comparable to our findings that 76.7% of ICU patients and 78.6% of ward patients treated with subcutaneous insulin had 1 or more BG values !180 mg/dL on measurement day 2. Wexler et al 30 also determined that use of basal insulin was associated with a higher prevalence of hyperglycemia and hypoglycemia in their study. Our regression analysis finding that long-acting (basal) insulin use was not associated with improvement in glycemic control is consistent with the findings of the aforementioned study.…”

Section: Discussionmentioning

confidence: 84%

“…29 In that study, 90% of patients had a sliding-scale order, 36% received an oral diabetes agent, and 43% received basal insulin at some time during hospitalization. A recently published analysis by Wexler et al 30 compiled data of hospitalized patients with diabetes from an earlier 2003 UHC Diabetes Benchmarking Project (n 5 274) and patients from 15 not-for-profit member hospitals of VHA, Incorporated (n 5 725) to examine the prevalence of hyperglycemia and hypoglycemia. Hyperglycemia (defined as a single BG value >200 mg/dL) was common, occurring in 77% of patients in the UHC cohort and 76% in the VHA, Inc. cohort.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of hospital glycemic control at US Academic Medical Centers

Boord

Greevy

Braithwaite

et al. 2009

Journal of Hospital Medicine

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OBJECTIVE:To evaluate contemporary hospital glycemic management in US academic medical centers.DESIGN: This retrospective cohort study was conducted on patients discharged from 37 academic medical centers between July 1 and September 30, 2004; 1,718 eligible adult patients met at least 1 of the inclusion criteria: 2 consecutive blood glucose readings >180 mg/dL within 24 hours, or insulin treatment at any time during hospitalization. We assessed 3 consecutive measurement days of glucose values, glycemic therapy, and additional clinical and laboratory characteristics. RESULTS:In this diverse cohort, 79% of patients had a prior diagnosis of diabetes, and 84.6% received insulin on the second measurement day. There was wide variation in hospital performance of recommended hospital diabetes care measures such as glycosylated hemoglobin (A1C) assessment (range, 3%-63%) and timely admission laboratory glucose measurement (range, 39%-97%). Median glucose was significantly lower for patients in the intensive care unit (ICU) compared to ward/intermediate care. ICU patients treated with intravenous insulin had significantly lower median glucose when compared to subcutaneous insulin. Only 25% of ICU patients on day 3 had estimated 6 AM glucose 110 mg/dL.Hyperglycemia was common, 50% of all patients had !1 glucose measurement !180 mg/dL on measurement days 2 and 3. Severe hypoglycemia (<50 mg/dL) occurred in 2.8% of all patient days. CONCLUSIONS:Despite frequent insulin use, glucose control was suboptimal.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Evaluation of hospital glycemic control at US Academic Medical Centers

Boord

Greevy

Braithwaite

et al. 2009

Journal of Hospital Medicine

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“…La hiperglicemia es significativa; dos tercios de los pacientes tienen al menos un episodio de glicemia superior a 200 mg/dl y uno de cada cinco presenta un episodio de hipoglicemia inferior a 70 mg/dl. Estudios similares publicados muestran cifras comparables a nuestra realidad; Schnniper et al, en un estudio prospectivo de 107 pacientes diabéticos en una unidad de medicina no crítica, publicado el año 2006, reporta 76% de pacientes con glicemias sobre 180 mg/dl y 11% de pacientes con un episodio de glicemia inferior a 60 mg/dl 20 ; un estudio de 44 hospitales de Estados Unidos de Norteamérica muestra 77% de pacientes con glicemias superiores a 200 mg/dl, y 12% de episodios de hipoglicemia bajo 60 mg/dl 21 . Sin duda, el control glicémico previo a la hospitalización tiene que ver con la evolución del paciente; sin embargo, también se han invocado factores como la inercia clínica, es decir, la falta de toma de decisiones respecto de la hiper o hipoglicemia, a la tolerancia ante cifras elevadas como grandes responsables de esta situación 5,22 Control glicémico en diabéticos hospitalizados en camas no críticas -I. Solís et al estos hechos.…”

Section: Discussionunclassified

Control glicémico de pacientes diabéticos hospitalizados en un Servicio de Medicina Interna

et al. 2012

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“…12 Just in patients with diabetes, however, hypoglycemia may occur in 12%-18% of cases, or highest percentage if treated with more aggressive glucose-lowering therapy. 13 In a retrospective review, among more than 4000 admissions in Internal Medicine Department, hypoglycemia was found in 8% of hospitalizations and in 3% of patients admitted. 14 In a study including data from 575 hospitals, hypoglycemia (blood glucose <70 mg/dL) occurred in 6.3% of patients admitted to the ICU and in 5.7% of patients in normal wards.…”

Section: Definition and Prevalence Of Hypoglycemiamentioning

confidence: 99%

The clinical impact of hypoglycemia in hospitalized patients

Borzı̀

Fontanella

2015

Ital J Med

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Hypoglycemia is a very common problem, mostly in frail, severely ill, older hospitalized patients. Hypoglycemia has been implicated in the development of adverse clinical outcomes, including an increased mortality. Fear of iatrogenic hypoglycemia remains an obstacle to adequate inpatient glycemic control. It may be considered as a marker of disease, rather than cause in itself of undesirable events. Several factors, such as treatment with exogenous insulin, mismatch between insulin administration and meal intake with the loss of normal counter regulatory responses, place patients with diabetes at higher risk for hypoglycemia than the ones without diabetes. In this review we discuss the causes and predictors of hypoglycemia in non-critically ill hospitalized patients and how to prevent them. Subcutaneous insulin with basal-bolus regimen rather than sliding scale and the use of analogues may minimize hypoglycemic events. In-patient glycemic management should be patient-centered, following the current guidelines, and aimed to prevent hypoglycemic events.Correspondence: Andrea Fontanella, Dipartimento di Medicina, Ospedale del Buon Consiglio Fatebenefratelli, via Manzoni 220, 80123 Napoli, Italy. E-mail: andreafontanella52@gmail.com Key words: hypoglycemia, diabetes, non-critical illness, inpatients.Received for publication: 6 October 2014. Accepted for publication: 3 December 2014.This work is licensed under a Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).

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Prevalence of Hyper- and Hypoglycemia Among Inpatients With Diabetes

Cited by 166 publications

References 23 publications

Evaluation of hospital glycemic control at US Academic Medical Centers

Evaluation of hospital glycemic control at US Academic Medical Centers

Control glicémico de pacientes diabéticos hospitalizados en un Servicio de Medicina Interna

The clinical impact of hypoglycemia in hospitalized patients

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