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Inpatient diabetology

The new frontier

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Abstract

Tight glycemic control is now an imperative of outpatient diabetes care. The inpatient arena remains under the influence of an ineffective paradigm characterized by tolerance for hyperglycemia and a reluctance to use insulin intensively. This article is a call to action against the lip service paid to inpatient diabetes care. The compelling in vitro and in vivo evidence for the benefit of intensive insulin-mediated glycemic control is summarized. The linchpin of current inpatient care is a commonly used insulin sliding scale. This autopilot approach as the sole mode of treatment for inpatient hyperglycemia has been strongly condemned. Nevertheless, it continues to survive. The evidence supports the compelling argument that the adverse effect of hyperglycemia on hospital length of stay, morbidity, and mortality is substantial. Clinicians, nurses, administrators, and insurers ought to look critically at the prevailing paradigm and spearhead the much-needed revolution in inpatient diabetology. The issue of glycemic targets, the need for noninvasive blood glucose monitoring, and the role of nursing staff in this revolution are raised. We call for the banning of the insulin sliding scale use as the sole diabetes order. Also, the use of basal insulin via continuous intravenous insulin infusion or subcutaneous insulin analogs should be embraced. Educating nurses, house staff, and other frontline professionals in the adverse consequences of the current paradigm is essential. Inpatient glycemic control matters; clinical and financial outcomes are at stake. It behooves the health care system and the diabetic public to address the contemporary state of inpatient diabetology as soon as possible.

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Author information

Authors and Affiliations

  1. University of Connecticut School of Medicine, USA

    Nicolas N. Abourizk MD

  2. the University of Connecticut Health Center, Farmington, Conn

    Chaula K. Vora MD & Parveen K. Verma DO

  3. Section of Endocrinology and Diabetes, Saint Francis Hospital and Medical Center, 114 Woodland Street, 06105, Hartford, CT

    Nicolas N. Abourizk MD

Authors
  1. Nicolas N. Abourizk MD
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  2. Chaula K. Vora MD
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  3. Parveen K. Verma DO
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Correspondence to Nicolas N. Abourizk MD.

Additional information

Editor’s Note: The American College of Endocrinology and the American Association of Clinical Endocrinologists released a position statement on “Inpatient Diabetes and Metabolic Control” calling for aggressive and tight glycemic control in the inpatient arena and setting target blood glucose levels for hospitalized diabetics. This is a happy development and lends a great deal of support to our call to action limned in our paper. The position statement can be accessed at http://www.aace.com/pub/ICC and will be published in the January/February 2004 issue of Endocrine Practice.

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Abourizk, N.N., Vora, C.K. & Verma, P.K. Inpatient diabetology. J GEN INTERN MED 19, 466–471 (2004). https://doi.org/10.1111/j.1525-1497.2004.30133.x

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