BACKGROUND: Hyperglycemia is common among diabetic inpatients, and has been linked to adverse outcomes. However, antihyperglycemic treatment is seldom intensified in noncritical care patients, and the relationship between intensification frequency and glucose control is poorly understood. We evaluated the relationship between treatment intensification and changes in blood glucose in hospitalized diabetic patients. DESIGN: We retrospectively analyzed 3,613 hospitalized diabetic patients who were admitted to the hospital between January 2003 and August 2004, were not hospitalized in an ICU, were not prescribed IV insulin or total parenteral nutrition (TPN), had a length of stay of at least 3 days, and had at least one point-of-care blood glucose measurement. A linear model was used to assess the relationship between intensification of antihyperglycemic medications and the average daily change in point-of-care glucose measurements. RESULTS: Hyperglycemia (>180 mg/dL) was documented at least once for 82.5% of patient admissions. Antihyperglycemic treatment was intensified for 22.0% of days with hyperglycemia. Intensifications of scheduled and sliding scale insulin, but not oral medications, were associated with a 11.1 mg/dL (p < 0.0001) and 12.2 mg/dL (p < 0.0001) reduction in the average daily glucose, respectively. Hypoglycemia (<50 mg/dL) was documented on 2.2% of days after antihyperglycemic treatment intensification. CONCLUSION: In this cohort, lack of treatment intensification in response to inpatient hyperglycemia was common. Antihyperglycemic treatment intensification was strongly associated with decrease in average daily glucose, while hypoglycemia was uncommon. This suggests that increasing the frequency of treatment intensifications could lead to improved glycemic control in inpatients with diabetes.
BACKGROUND:Hyperglycemia is common among diabetic inpatients, and has been linked to adverse outcomes. However, antihyperglycemic treatment is seldom intensified in noncritical care patients, and the relationship between intensification frequency and glucose control is poorly understood. We evaluated the relationship between treatment intensification and changes in blood glucose in hospitalized diabeticpatients. DESIGN: We retrospectively analyzed 3,613 hospitalized diabeticpatients who were admitted to the hospital between January 2003 and August 2004, were not hospitalized in an ICU, were not prescribed IV insulin or total parenteral nutrition (TPN), had a length of stay of at least 3 days, and had at least one point-of-care blood glucose measurement. A linear model was used to assess the relationship between intensification of antihyperglycemic medications and the average daily change in point-of-care glucose measurements. RESULTS:Hyperglycemia (>180 mg/dL) was documented at least once for 82.5% of patient admissions. Antihyperglycemic treatment was intensified for 22.0% of days with hyperglycemia. Intensifications of scheduled and sliding scale insulin, but not oral medications, were associated with a 11.1 mg/dL (p < 0.0001) and 12.2 mg/dL (p < 0.0001) reduction in the average daily glucose, respectively. Hypoglycemia (<50 mg/dL) was documented on 2.2% of days after antihyperglycemic treatment intensification. CONCLUSION: In this cohort, lack of treatment intensification in response to inpatient hyperglycemia was common. Antihyperglycemic treatment intensification was strongly associated with decrease in average daily glucose, while hypoglycemia was uncommon. This suggests that increasing the frequency of treatment intensifications could lead to improved glycemic control in inpatients with diabetes.
Authors: G van den Berghe; P Wouters; F Weekers; C Verwaest; F Bruyninckx; M Schetz; D Vlasselaers; P Ferdinande; P Lauwers; R Bouillon Journal: N Engl J Med Date: 2001-11-08 Impact factor: 91.245
Authors: L S Phillips; W T Branch; C B Cook; J P Doyle; I M El-Kebbi; D L Gallina; C D Miller; D C Ziemer; C S Barnes Journal: Ann Intern Med Date: 2001-11-06 Impact factor: 25.391
Authors: Alan J Garber; Etie S Moghissi; Edwin D Bransome; Nathaniel G Clark; Stephen Clement; Rhoda H Cobin; Anthony P Furnary; Irl B Hirsch; Philip Levy; Robert Roberts; Greet Van den Berghe; Virginia Zamudio Journal: Endocr Pract Date: 2004 Jan-Feb Impact factor: 3.443
Authors: Guillermo E Umpierrez; Scott D Isaacs; Niloofar Bazargan; Xiangdong You; Leonard M Thaler; Abbas E Kitabchi Journal: J Clin Endocrinol Metab Date: 2002-03 Impact factor: 5.958
Authors: Steven M Brunelli; Sushrut S Waikar; Brian T Bateman; Tara I Chang; Joyce Lii; Amit X Garg; Wolfgang C Winkelmayer; Niteesh K Choudhry Journal: Am J Med Date: 2012-10-09 Impact factor: 4.965
Authors: Kathryn E Coan; Andrew B Schlinkert; Brandon R Beck; Danielle J Haakinson; Janna C Castro; Heidi A Apsey; Richard T Schlinkert; Curtiss B Cook Journal: J Diabetes Sci Technol Date: 2013-07-01