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GENERAL MEDICINE

Hyperglycemia in the Hospital Setting: The Case for Improved Control Among Non-Diabetics

Health Economist, Brain and Spine Center, Seton Healthcare Network, Austin, TX

Kelly R Flesner-Gurley, MD

at time of writing, Internal Medicine Faculty Member, Austin Medical Education Program, Brackenridge Hospital, Seton Healthcare Network, Austin, TX; now, Endocrinologist, St. John Medical Center, Tulsa, OK

Jamie C Barner, PhD

Associate Professor, College of Pharmacy, The University of Texas at Austin, PHAR-Pharmacy Administration, Austin

Reprints: Dr. Conner, Brain and Spine Center, Seton Healthcare Network, 601 E. 15th St., Austin, TX 78701-1096, fax 512/324-7051, tmconner{at}seton.org

OBJECTIVE: To review studies on the role of hyperglycemia in acutely ill adults, regardless of diabetes diagnosis, and the impact of glucose control on health outcomes.

DATA SOURCES: Searches on Ovid MEDLINE, Ovid Evidence-Based Medicine (EBM), and PubMed MEDLINE, limited to articles written in English, trials conducted on adult subjects, and material published between 1994 and April 2004. Search words included the major MeSH term hyperglycemia and title words glucose, hyperglycemia/hyperglycemic, or insulin therapy, with text words admission, hospitalized, inhospital, or inpatient.

STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated, and all information deemed relevant was included in this review.

DATA SYNTHESIS: Hyperglycemia, even in patients without diabetes, has been shown to be detrimental among inpatients in medical and surgical units, as well as in critical care. A review of 25 outcomes studies indicated that the majority of research on this topic used retrospective or prospective cohort designs; only 2 were conducted as randomized controlled studies. In general, the findings demonstrated negative impact on outcomes among various patient populations with hyperglycemia including increased lengths of stay, health complications, utilization of resources, and risk of mortality.

CONCLUSIONS: Studies report that hyperglycemia is a common but detrimental condition and that better control in the hospital setting decreases short- and long-term risk of mortality, illness complications, hospital lengths of stay, and healthcare costs. Increased efforts to treat hyperglycemia and screen for diabetes are needed in the hospital setting. Future studies on cost-effective approaches to glucose control are recommended.

Key Words: hospital, hyperglycemia, insulin, non-diabetic patients

Published Online, February 8, 2005. www.theannals.com, DOI 10.1345/aph.1E308

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-05-010-H01

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