Current standards of care for inpatient glycemic management and metabolic control: is it time for definite standards and targets?

OBJECTIVE: To review the available literature on the presence of diabetes in the inpatient population and its effect on outcomes.
RESULTS: Diabetes is a progressively worsening epidemic in the United States. Patients with diabetes have a disproportionate representation among the inpatient population in this country, and their share of total health-care costs is both disproportionate and growing rapidly. Patients with diabetes are often admitted to the hospital not primarily because of their diabetes but rather because of the need for treatment of the end-stage complications of diabetes, such as cardiovascular, cerebrovascular, and peripheral vascular disease as well as diabetic nephropathy and retinopathy, or because of unrelated illnesses for which diabetes is a complication. Diabetes is a frequent comorbid condition and increases the duration of hospitalization by 1 to 2 days. Numerous organizations have issued guidelines for outpatient diabetes management and metabolic control and have updated them periodically; however, no such guidelines or standards have been formulated for inpatient diabetes management.
CONCLUSION: In view of a rapidly growing body of evidence suggesting that enhanced glycemic control decreases morbidity and mortality in patients with hyperglycemia, such as those with new-onset diabetes, as well as in patients with previously established diabetes, the creation of clearly defined standards and targets for inpatient management of hyperglycemia and metabolic control seems important for improvement of outcomes in hospitalized patients with diabetes.