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Diabetes In Hospital

Management Of Diabetes Mellitus In Hospitalized Patients

Management Of Diabetes Mellitus In Hospitalized Patients

INTRODUCTION Patients with type 1 or type 2 diabetes mellitus are frequently admitted to a hospital, usually for treatment of conditions other than the diabetes [1,2]. In one study, 25 percent of patients with type 1 diabetes and 30 percent with type 2 diabetes had a hospital admission during one year; patients with higher values for glycated hemoglobin (A1C) were at highest risk for admission [2]. The prevalence of diabetes rises with increasing age, as does the prevalence of other diseases; both factors increase the likelihood that an older person admitted to a hospital will have diabetes. The treatment of patients with diabetes who are admitted to the general medical wards of the hospital for a procedure or intercurrent illness is reviewed here. The treatment of hyperglycemia in critically ill patients, the perioperative management of diabetes, and the treatment of complications of the diabetes itself, such as diabetic ketoacidosis, are discussed separately. (See "Glycemic control and intensive insulin therapy in critical illness" and "Perioperative management of blood glucose in adults with diabetes mellitus" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Treatment" and "Management of hypoglycemia during treatment of diabetes mellitus".) GOALS IN THE HOSPITAL SETTING The main goals in patients with diabetes needing hospitalization are to minimize disruption of the metabolic state, prevent adverse glycemic events (especially hypoglycemia), return the patient to a stable glycemic balance as quickly as possible, and ensure a smooth transition to outpatient care. These goals are not always easy to achieve. On the one hand, the stress of the acute illness tends to raise blood glucose concentrations. On the other hand, the anorexia that often a Continue reading >>

Management Of Diabetes And Hyperglycemia In Hospitalized Patients

Management Of Diabetes And Hyperglycemia In Hospitalized Patients

Go to: INTRODUCTION Diabetes is a prevalent metabolic disorder that affects more than 415 million people globally [1]. Globally, diabetes care has been estimated at $1.31trillion [2]. Further, according to the International Diabetes Federation, 1 in 10 adults will have diabetes by 2040 [1]. In the United States, data from the National Diabetes Statistics reported in 2012 that a total of 29.1 million Americans, or 9.3% of the population, had diabetes [3]. The percentage of the population with diagnosed diabetes is expected to rise, with one study projecting that as many as one in three U.S. adults will have diabetes by 2050 [4]. Patients with diabetes have a 3-fold greater chance of hospitalization compared to those without diabetes [5,6], and it is estimated that more than 20% of all adults discharged have diabetes, with 30% of them requiring 2 or more hospitalizations in any given year [5-7]. In 2012 in the U.S., there were over 7.7 million hospital stays for patients with diabetes (i.e., diabetes as either a principal diagnosis for hospitalization or as a secondary diagnosis, coexisting condition) and in the UK the 2016 National Diabetes Inpatient Audit suggested that the prevalence of diabetes amongst inpatients had risen from 15% in 2010 to 17% in 2016 [8]. In addition, patients hospitalized with a diagnosis of diabetes stay in the hospital for longer than those without a diagnosis of diabetes admitted for the same condition [9]. Diabetes remains the 7th leading cause of death in the United States in 2014, with 76,488 death certificates listing it as the underlying cause of death, accouting for 24 deaths per 100,000 of the population [10]. The care of patients with diabetes imposes a substantial burden on the economy, with a total estimated cost of diagnosed diabete Continue reading >>

Managing Adults With Diabetes In Hospital During An Acute Illness

Managing Adults With Diabetes In Hospital During An Acute Illness

What you need to know In general, do not stop insulin treatment in a person with type 1 diabetes; if the person is used to carbohydrate counting and correction dosing, encourage them to self correct Assess a person with acute hyperglycaemia as a whole, taking into account their clinical condition, previous glucose control, and factors that may be contributing to hyperglycaemia Involve the diabetes specialist team if available at an early stage, especially for patients struggling with their diabetes management. Diabetes is common and becoming commoner. Data from the UK National In-patient Diabetes Audit (NADia) suggests that around 1 in 5 inpatient beds are occupied by a person with diabetes and that diabetes can often be poorly managed in hospital, with around 1 in 10 in patients developing a severe hypoglycaemic episode and around 1 in 4 inpatient charts showing medication management errors in the preceding seven days.1 This article highlights the principles of managing adult patients in hospital with diabetes who are acutely unwell and is aimed at non-specialists. We searched Pubmed, Google Scholar, CINAHL, and the Cochrane Database using the terms “management of diabetes/hyperglycaemia in hospital” and “management of diabetes during acute illness.” We reviewed guidelines from the Joint British Diabetes Societies, National Institute for Health and Clinical Excellence, European Association for the Study of Diabetes, and American Diabetes Association. Is tight glucose control in inpatients necessary? Poorly managed hyperglycaemia in patients who are acutely unwell can lead to adverse outcomes in terms of morbidity, mortality, and longer hospital stay.2 There is, however, no randomised trial evidence to demonstrate that tight management of glucose control in inpa Continue reading >>

Hospital Guidelines For Diabetes Management And The Joint Commission-american Diabetes Association Inpatient Diabetes Certification☆

Hospital Guidelines For Diabetes Management And The Joint Commission-american Diabetes Association Inpatient Diabetes Certification☆

Jump to Section Abstract Background The Joint Commission Advanced Inpatient Diabetes Certification Program is founded on the American Diabetes Association’s Clinical Practice Recommendations and is linked to the Joint Commission Standards. Diabetes currently affects 29.1 million people in the USA and another 86 million Americans are estimated to have pre-diabetes. On a daily basis at the Medical University of South Carolina (MUSC) Medical Center, there are approximately 130-150 inpatients with a diagnosis of diabetes. Methods The program encompasses all service lines at MUSC. Some important features of the program include: a program champion or champion team, written blood glucose monitoring protocols, staff education in diabetes management, medical record identification of diabetes, a plan coordinating insulin and meal delivery, plans for treatment of hypoglycemia and hyperglycemia, data collection for incidence of hypoglycemia, and patient education on self-management of diabetes. Results The major clinical components to develop, implement, and evaluate an inpatient diabetes care program are: I. Program management, II. Delivering or facilitating clinical care, III. Supporting self-management, IV. Clinical information management and V. performance measurement. The standards receive guidance from a Disease-Specific Care Certification Advisory Committee, and the Standards and Survey Procedures Committee of the Joint Commission Board of Commissioners. Conclusions The Joint Commission-ADA Advanced Inpatient Diabetes Certification represents a clinical program of excellence, improved processes of care, means to enhance contract negotiations with providers, ability to create an environment of teamwork, and heightened communication within the organization. Continue reading >>

13. Diabetes Care In The Hospital

13. Diabetes Care In The Hospital

Consider performing an A1C on all patients with diabetes or hyperglycemia admitted to the hospital if not performed in the prior 3 months. C Insulin therapy should be initiated for treatment of persistent hyperglycemia starting at a threshold ≥180 mg/dL (10.0 mmol/L). Once insulin therapy is started, a target glucose range of 140–180 mg/dL (7.8–10.0 mmol/L) is recommended for the majority of critically ill patients A and noncritically ill patients. C More stringent goals, such as 110–140 mg/dL (6.1–7.8 mmol/L) may be appropriate for selected critically ill patients, as long as this can be achieved without significant hypoglycemia. C Intravenous insulin infusions should be administered using validated written or computerized protocols that allow for predefined adjustments in the insulin infusion rate based on glycemic fluctuations and insulin dose. E A basal plus bolus correction insulin regimen is the preferred treatment for noncritically ill patients with poor oral intake or those who are taking nothing by mouth. An insulin regimen with basal, nutritional, and correction components is the preferred treatment for patients with good nutritional intake. A The sole use of sliding scale insulin in the inpatient hospital setting is strongly discouraged. A A hypoglycemia management protocol should be adopted and implemented by each hospital or hospital system. A plan for preventing and treating hypoglycemia should be established for each patient. Episodes of hypoglycemia in the hospital should be documented in the medical record and tracked. E The treatment regimen should be reviewed and changed if necessary to prevent further hypoglycemia when a blood glucose value is <70 mg/dL (3.9 mmol/L). C There should be a structured discharge plan tailored to the individual p Continue reading >>

Inpatient Management Of Diabetes Mellitus

Inpatient Management Of Diabetes Mellitus

Background Diabetes is a chronic condition marked by high levels of glucose in the blood. It is caused either by the inability to produce insulin (a hormone produced by the pancreas to control blood glucose levels) or by the body not being able to use insulin effectively. Diabetes can lead to acute and chronic complications. In an acute hospital setting, high blood sugar (hyperglycaemia) can increase risk of infection and other adverse outcomes. Chronic high blood glucose levels are associated with long-term damage, dysfunction and failure of virtually every organ, especially the heart and blood vessels, eyes, kidneys and nerves. One in 11 people aged over 16 in NSW has diabetes[1]. A 2014 Australian hospital audit of point prevalence data demonstrated that one in four inpatients had self-reported diabetes[2]. Diabetes accounts for 11% of all NSW public hospital hospitalisations with an average length of stay of 6 days (3 days longer than a person who does not have diabetes)[3], which may be related to an increased risk of infection or other adverse outcomes consequent to inpatient hyperglycaemia[4] or hypoglycaemia. Type 2 diabetes accounts for about 85-90% of diabetes hospitalisations in NSW[1]. What clinical processes need to change? The ACI Endocrine Network and NSW Diabetes Taskforce identified the need to implement a state-wide approach to improve glucose management for patients with diabetes in hospital in order to improve patient experience; reduce adverse events and hospital length of stay; and avoid failed hospital discharge. Glycaemic instability is commonly observed among inpatients with diabetes[4]. Patients with diabetes are frequently admitted to hospital for treatment of conditions other than the diabetes. Therefore, insulin orders, administration and gl Continue reading >>

Diabetes Care In Hospital

Diabetes Care In Hospital

Tweet If you’re admitted to hospital, either for a planned visit such as surgery or for an emergency, you should expect to receive good quality care during your stay. To help ensure that your care is appropriate, you can ask for a care plan to be drawn up either before your visit or during it. Managing your diabetes in hospital Depending on the circumstances, you may be able to manage your diabetes. A diabetes care plan should be drawn up to help with how your diabetes is managed during your hospital stay. The care plan will outline the care you can expect to receive, how high and low blood glucose needs to managed, any dietary requirements that need to be taken into account, whether you’d like to involve a relative or carer and whether you have any requirements based on cultural or religious needs. Will I be able to use my medication and diabetes equipment in hospital? In some cases you will be able to administer your own diabetes treatment. The hospital team may decide to temporarily change your treatment routine whilst you are in hospital however. Typical changes may include putting people who normally take tablets onto insulin. People taking insulin may have their dosages altered during their stay to prevent the chance of hypoglycemia. Will the hospital be able to cope with my dietary needs? The food in hospital should be able to meet a number of dietary requirements, such as vegetarian and vegan. If you are used to eating a low carb diet, you may need to make some compromises but the hospital should provide a variety of options which should help. Some people with diabetes may wish to receive snacks at specific times, which the hospital should be able to accommodate. You should have access to see an NHS dietitian during your stay if required. Formalities when le Continue reading >>

A Practical And Evidence-based Approach To Management Of Inpatient Diabetes In Non-critically Ill Patients And Special Clinical Populations

A Practical And Evidence-based Approach To Management Of Inpatient Diabetes In Non-critically Ill Patients And Special Clinical Populations

Highlights • Inpatient diabetes control in non-ICU patients can improve clinical outcomes. • Insulin administration is a mainstay of hyperglycemia management in the wards. • Avoidance of hypoglycemia is important during glycemia management. • Several diabetes patient groups will require different treatment approach. • Future glycemia treatment algorithms should allow individualization of therapy. Abstract Inpatient diabetes is a common medical problem encountered in up to 25–30% of hospitalized patients. Several prospective trials showed benefits of structured insulin therapy in managing inpatient hyperglycemia albeit in the expense of high hypoglycemia risk. These approaches, however, remain underutilized in hospital practice. In this review, we discuss clinical applications and limitations of current therapeutic strategies. Considerations for glycemic strategies in special clinical populations are also discussed. We suggest that given the complexity of inpatient glycemic control factors, the “one size fits all” approach should be modified to safe and less complex patient-centered evidence-based treatment strategies without compromising the treatment efficacy. Continue reading >>

Controlling Hyperglycemia In The Hospital: A Matter Of Life And Death

Controlling Hyperglycemia In The Hospital: A Matter Of Life And Death

IN BRIEF Six million U.S. hospitalizations per year are accompanied by hyperglycemia. The degree of hyperglycemia may be an important predictor of morbidity and mortality among patients with myocardial infarction or stroke and those undergoing surgical procedures, including coronary artery bypass. Hyperglycemia should be aggressively controlled from the time of admission regardless of patients' primary medical problem or previous diabetes status. New methodologies for identifying, monitoring, and treating hyperglycemia are needed. The data on the importance of controlling glucose in hospital settings spans diverse disciplines of medicine. Studies in the areas of stroke, myocardial infarction (MI), bypass surgery, and wound and nosocomial infections all point to the tremendous potential to reduce morbidity and mortality among hospitalized patients with hyperglycemia. It is essential to identify hyperglycemia at the time of hospital admission and to implement therapy to achieve and maintain glucose levels as close to normal as possible, regardless of a patient's primary reason for admission or previous diabetes status. In the United States, there are more than 4.2 million hospitalizations annually among people with diabetes.1 Additionally, as many as 1.5 million hospitalized individuals have significant hyperglycemia but no history of diabetes.2 Identification of and therapeutic interventions to treat hyperglycemia must be initiated in tandem with treatment of the presenting medical problem rather than days after admission when many of the acute issues have been addressed. The data presented strongly suggest that an early and aggressive approach to the management of hyperglycemia may reduce mortality, morbidity, excessive hospital stays, and added costs. Why is hyperglyce Continue reading >>

Management Of Type 1 Diabetes In The Hospital Setting

Management Of Type 1 Diabetes In The Hospital Setting

Abstract The purpose of this article was to review recent guideline recommendations on glycemic target, glucose monitoring, and therapeutic strategies, while providing practical recommendations for the management of medical and surgical patients with type 1 diabetes (T1D) admitted to critical and non-critical care settings. Studies evaluating safety and efficacy of insulin pump therapy, continuous glucose monitoring, electronic glucose management systems, and closed loop systems for the inpatient management of hyperglycemia are described. Due to the increased prevalence and life expectancy of patients with type 1 diabetes, a growing number of these patients require hospitalization every year. Inpatient diabetes management is complex and is best provided by a multidisciplinary diabetes team. In the absence of such resource, providers and health care staff must become familiar with the features of this condition to avoid complications such as severe hyperglycemia, ketoacidosis, hypoglycemia, or glycemic variability. We reviewed most recent guidelines and relevant literature in the topic to provide practical recommendations for the inpatient management of patients with T1D. Notes Carlos E. Mendez and Guillermo E. Umpierrez declare that they have no conflict of interest. This article does not contain any studies with human or animal subjects performed by any of the authors. Continue reading >>

Diabetes: Hospitals Ramping Up Inpatient Care

Diabetes: Hospitals Ramping Up Inpatient Care

Diabetes Framing the Issue Diabetes is common in the hospital. The condition was a primary or secondary diagnosis in more than 5.3 million hospital discharges in 2010. The disease puts patients at higher risk of serious complications in the hospital. These include dangerous blood sugar levels, falls, infections and pressure ulcers. Medicare penalties for excess readmissions and high rates of health care-acquired conditions make blood sugar control a high priority for hospitals. Diabetes as a principal or secondary diagnosis can increase patient lengths of stay, which decreases hospital revenue. The mean length of stay for diabetic patients was 5.3 days in 2008, compared with 4.4 days for patients without the condition. At any given time, one-third or more of patients in most hospitals have high blood sugar, typically caused by diabetes. These patients are at higher risk of serious complications: infections, falls, pressure ulcers and harmful or even deadly high or low blood sugar swings. Medicare payment penalties for having high rates of health care-acquired conditions and for excess readmissions mean that hospitals must have systems in place to manage patients' blood sugar or run the risk not only of bad patient outcomes, but also financial losses. "What hospitals should be doing is identifying diabetic patients when they come in and doing whatever they can to prevent that patient from getting any kind of hospital-acquired issue," says Hazel R. Seabrook, a managing director at Huron Consulting Group, Chicago. But inpatient stays have to include more than blood sugar management. "Hospitals should also do appropriate discharge planning for diabetic patients so the patient gets discharged to the next care setting with the right education and the right follow-up care, so Continue reading >>

The High Burden Of In-hospital Diabetes Mellitus At A Tertiary Care Hospital In Sri Lanka; A Case Control Study

The High Burden Of In-hospital Diabetes Mellitus At A Tertiary Care Hospital In Sri Lanka; A Case Control Study

1Senior Lecturer in Medicine, Department of Medicine, University of Peradeniya, Sri Lanka 2Senior Registrar in Medicine, Professorial Medical Unit, Teaching Hospital Peradeniya, Sri Lanka 3Temporary Lecturer, Faculty of Medicine, Department of Medicine, University of Peradeniya, Sri Lanka Citation: Medagama AB, Bandara R, Wijetunge R (2015) The High Burden of In-Hospital Diabetes Mellitus at A Tertiary Care Hospital in Sri Lanka; A Case Control Study. J Diabetes Metab 6:502. doi: 10.4172/2155-6156.1000502 Copyright: © 2015 Medagama AB, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Diabetes & Metabolism Abstract Background: Sri Lanka has a very high prevalence of diabetes with poorly organized diabetes care and limited resources for in-patient management. At present, 10.3% of the population is diabetic. Aim: The aim of this study was to define the reasons for admission of diabetic patients to a tertiary care general medical unit, to calculate the point prevalence of diabetes related admissions, the mean duration of hospital stay and assess their in-hospital glycaemic control. Design: A case-control study. Methods: Data of 300 consecutive diabetic and non-diabetic admissions to the professorial medical unit at Teaching Hospital Peradeniya were studied between 30th May and 30th August 2011. Results: The in-hospital point prevalence of diabetes was 40.4%. One quarter of diabetes related admissions were for control of hyperglycaemia. Twenty two percent were for acute coronary syndromes and another 16% for treatment of infections. Mean Continue reading >>

Role Of The Diabetes Educator

Role Of The Diabetes Educator

2016 American Association of Diabetes Educators, Chicago, IL 1 Role of the Diabetes Educator in Inpatient Diabetes Management August 2016 Diabetes educators are a valuable asset to the interdisciplinary team and are uniquely prepared to facilitate change and implement processes and programs to improve glycemic control.19, 20 Diabetes educators play a key leadership role in creating or implementing:  interdisciplinary teams (related to quality improvement, patient or medication safety, documentation/tool development, clinical informatics & decision support)  comprehensive staff diabetes education  the collection of blood glucose data and the surveillance of outcome measurements  evidence-based hypoglycemia and hyperglycemia management order sets and protocols (as well as monitoring, tracking, and root cause analysis to prevent errors and patient harm)  individualized medication management plans within the hospital setting and for use after discharge, and  a plan of care that facilitates a smooth transition across the care settings  The diabetes educator’s responsibility as a leader or member of the interdisciplinary team includes input into patient education, identifying barriers to care, care coordination and transition, nutrition therapy, medication therapy and management, hypoglycemia management and prevention, monitoring glycemic control, and professional education.19, 21-23 All components of hospital care that affect inpatient glycemia need to be considered in initiatives to improve inpatient care.12, 17, 24-27 Diabetes mellitus is the second most common diagnosis for those discharged from hospitals among adults age 18 and older.1 Patients with diabetes are frequently hospitalized, for treatment of conditions o Continue reading >>

Diabetes Care In The Hospital: It Ain't Pretty

Diabetes Care In The Hospital: It Ain't Pretty

Two ER visits within two days, thanks to a severe low blood sugar and then non-budging high blood sugars. Both are enough to make anyone with diabetes cringe. But then there's the fact that these experiences themselves highlighted how the urgent care establishment is ill-equipped to deal with diabetes. And it gets even more troublesome. I've long believed that we PWDs (people with diabetes) aren't going to get quality care in the emergency room if we end up there. From the Diabetes Community stories I've heard, opinions of medical professionals in the diabetes world, and my own experiences visiting ERs on a few occasions through my life, that is what I have come to believe. Sure, it may be more sarcastic than serious to say "the ER is trying to kill me," but there's certainly some real-world trauma weaved into that comment. The recent dual ER visits that my mom experienced reaffirm this, and I just want to share this story as a way to call out for whatever change can hopefully materialize ... I'm not happy with what happened in the ER relating to my mom last week. But more than that, it scares me that this type of thing could happen to any of us. What Happened? First, it's important to remember that my mom has been living with type 1 since the age of five -- which means it's now about 55 years. She hasn't had an A1C above 6% in at least a decade, and from what I have seen she doesn't often go above 160 for any extended period of time. She has had insulin reactions before, and they've been severe in some cases, but they typically don't last very long and we've all been able to manage them. Early on a recent Sunday morning, my didn't wake up from a hypoglycemic reaction. My dad awoke to her beeping Dexcom G4 continuous glucose monitor (CGM), and it showed that she was und Continue reading >>

What To Expect In The Hospital

What To Expect In The Hospital

“The wish for healing has ever been the half of health.” —Seneca the Younger Most people experience a stay in the hospital at least once in their lives, and for some, it is much more often than that. No matter what the reason for your admission to the hospital, it is imperative that your blood glucose levels be controlled while you are there. More and more research shows that maintaining optimal blood glucose control in the hospital improves a person’s chances of having the best possible medical outcome. However, achieving optimal control in the hospital is a challenge. Stress tends to raise blood glucose level, and in the hospital, the stresses are many: Illness itself is a physical stress, as are pain, surgery, and other medical procedures such as having blood drawn for tests. Simply being in the hospital is a physical and mental stress with all of the changes in routine. And worrying about the reason you’re in the hospital, whether your diabetes is being controlled properly, how much the hospitalization is going to cost you, how your family or job is making out without you, etc., simply adds to it. If your hospital admission is not an emergency, you and your health-care provider have more time to prepare so that some of the stress of being in the hospital can be minimized. For example, you can establish ahead of time whether your personal physician will be overseeing your care while you’re in the hospital or, if not, who will. You can also discuss how your diabetes will be controlled and whether and when to stop taking any medicines you may currently take. And you can make plans for dealing with such personal responsibilities as child care or pet care during your hospital stay. If you are admitted to the hospital through the emergency room, it is standard Continue reading >>

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