Purpose: Inpatient hyperglycemia is associated with poor outcomes. Existing research assessing inpatient hyperglycemia protocols has shown improvements in average blood glucose levels with inconsistent results regarding rates of hypoglycemia and hyperglycemia. The objective of this study was to evaluate the impact of an inpatient hyperglycemia protocol on glycemic control.
Methods: This retrospective cohort study at a large, community teaching hospital included adult patients in non-critical care units requiring insulin administration for glycemic control. The intervention examined was utilization of an inpatient hyperglycemia protocol, comprised of a computerized physician order entry order set and provider education at the time of implementation. Two cohorts, a pre-protocol implementation group and a post-protocol implementation group, were compared. The primary outcome was the incidence of blood glucose values within 70-180 mg/dL over a 72-hour period between groups. Key secondary outcomes included the incidence of hypoglycemia (less than 70 mg/dL), severe hyperglycemia (above 300 mg/dL), total insulin use, and hospital length of stay.
Results: The primary outcome was significantly improved following protocol implementation (54.2% vs. 58.4%, p = 0.001). Compared to the pre-protocol group, the post-protocol group had lower incidence of hypoglycemia (3.1% vs. 1.2%, p < 0.001), severe hyperglycemia (9.9% vs. 6.7%, p < 0.001), less total insulin use (1.1 units/kg vs. 0.6 units/kg, p < 0.001), and shorter length of stay (5.1 days vs. 3.7 days, p < 0.001).
Conclusions: The implementation of an inpatient hyperglycemia protocol was associated with improved glycemic control, decreased incidence of both hypoglycemia and severe hyperglycemia, and less total insulin use.
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Cureus
November 2024
Medicine, SGT Medical College, Hospital and Research Institute, Gurugram, IND.
Objective: This research aimed to assess the prevalence, presentation, and risk factors associated with hypoglycemia in non-critically ill vs. critically ill inpatients at a tertiary care hospital in North India, focusing on identifying differences in clinical parameters and outcomes between these two patient populations over six months.
Methodology: This six-month prospective study, conducted at a tertiary care hospital in North India, evaluated the frequency, presentation, and prevention of hypoglycemia in 200 hospitalized patients, evenly divided between non-critically ill and critically ill groups.
BMC Cardiovasc Disord
December 2024
Prince Faisal bin Khalid Cardiac Centre, Abha, Saudi Arabia.
Background: Stress hyperglycaemia ratio (SHR) has been reported to be independently and significantly associated with various adverse cardiovascular events as well as mortality. Moreover, in-hospital heart failure following acute myocardial infarction has been demonstrated to account for majority of all heart failure (HF) cases with anterior myocardial infarction showing higher rates of HF. However, the association between SHR and in-hospital HF following an anterior ST-elevation myocardial infarction (STEMI) has not been reported earlier.
View Article and Find Full Text PDFWorld J Diabetes
December 2024
Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China.
Background: Chronic hyperglycemia can damage the microcirculation, which impairs the function of various organs and tissues and predisposes individuals to chronic complications. Sarcopenia (SP) is the age-related decline in muscle mass and function that contributes to the sequelae of type 2 diabetes. In particular, diabetic patients are at higher risk of SP because of insulin resistance, chronic inflammation, and decreased physical activity.
View Article and Find Full Text PDFEur J Intern Med
December 2024
CIBERESP-IBIS-ROCIO-University Hospital, Fundación Enebro, Seville, Spain.
Background: Over the past decade, diabetes mellitus (DM) has emerged as a growing epidemic, with a direct link to an increased risk of hospitalization and a strong effect of glycemic control on clinical outcomes. The aim of this document was to critically appraise and adapt existing clinical practice guidelines (CPGs) to provide specific recommendations for the management of hyperglycemia in hospitalized adults with and without previously known DM, in an attempt to provide a practical tool to reduce the risk of major in-hospital complications.
Methods: The first step of the adaptation process was to identify unsolved clinical questions (PICOs) in hospitalized persons with hyperglycemia.
Ann Intern Med
December 2024
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (A.D.).
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