Etiology and effect on outcomes of hyperglycemia in hospitalized patients.

PURPOSE: The prevalence of diabetes in U.S. hospitals, etiology and pathophysiology of hyperglycemia in hospitalized patients, impact of hyperglycemia on patient outcomes, and benefits of hyperglycemia correction are described.
SUMMARY: Diabetes mellitus is a common and costly condition with an increasing prevalence in the U.S. Hyperglycemia is common among hospital patients with and without diabetes. Possible causes of hyperglycemia include illness-related metabolic stress, parenteral nutrition, and pharmacotherapy. The deposition of advanced glycosylation end products, capillary basement membrane thickening, impaired immune function, oxidative stress, impaired lipid metabolism, prothrombotic changes, activation of protein kinase C-beta, vascular leakage, capillary non perfusion, and induction of vascular endothelial growth factor are among the harmful effects of hyperglycemia. In various types of patients and hospital settings, hyperglycemia increases the mortality rate, risk of postoperative nosocomial infection, need for intensive care unit admission, length of hospital stay, and hospital charges. The benefits of using intensive therapy to correct hyperglycemia in hospitalized patients in reducing mortality and the risk of infections and other adverse outcomes are well documented.
CONCLUSION: Efforts are needed to manage hyperglycemia in hospitalized patients with and without diabetes to minimize the morbidity, mortality, and costs associated with hyperglycemia.