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New Recommendations For Inpatient Diabetes Management

Posted May 09 2009 11:27pm
The American Association of Clinical Endocrinologists (AACE) and American Diabetes Association (ADA) are recommending changes in goals for blood sugar control in hospitalized patients.

Just this past March,we discussedhow we had been hesitant to adopt the intensive algorithms that had been proposed for tight control of the blood sugar in the hospital, especially in intensive care settings. Our major concern had been that the algorithms proposed were largely developed by so-calledintensivist physiciansthat may have surprisingly little experience managing diabetes and complex insulin regimens.

The authors recommend revised glucose targets of 140-180 mg/dL in the ICU setting, and between 100-180 mg/dL for most patients admitted to general medical-surgical wards.

“We are witnessing an evolution in the management of hyperglycemia in inpatient settings,” Dr. Etie S. Moghissi, AACE Chair of the Inpatient Glycemic Control Consensus Panel said. “Despite some inconsistencies in the clinical trial results, it would be a serious error to conclude that judicious control of glycemia in hospitalized patients is not warranted.”

The following excerpt highlights one of our most significant frustrations. Patients followed in our practice are, from time to time, admitted to hospitals for a variety of reasons. However, we often don't learn of this until they tell us at their next routine office visit. During the hospital stay, their diabetes treatment regimens may be adjusted significantly .... but no one thinks about how that adjusted treatment regimen will plug into the "real world" after they are discharged ... and we're not aware the transition has to be made. Therefore, we're then called by a visiting nurse, or concerned family member, to take care of an emergent problem that is, essentially, "dumped in our lap". It's significantly more difficult to assist the patient without any knowledge of how they might have gotten into trouble.

“The responsibility for management of hyperglycemia shifts from the health care team to the patient following hospital discharge,” said Dr. Mary Korytkowski, ADA Chair of the Inpatient Glycemic Control Consensus Panel. “It is therefore important that patients receive the information necessary to safely manage this aspect of their care once they are at home.”

The full joint press release from the AACE and ADA ishere.

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