Management of Inpatient Hyperglycemia

Autor: Lowell R Schmeltz
Rok vydání: 2011
Předmět:
Zdroj: Laboratory Medicine. 42:427-434
ISSN: 1943-7730
0007-5027
Popis: Hyperglycemia occurs frequently in hospitalized patients and affects patient outcomes, including mortality, inpatient complications, length of stay, and overall hospital costs. Various degrees of glycemic control have been studied and a recent consensus statement from American Diabetes Association (ADA)/American Association of Clinical Endocrinologists (AACE) recommends a target glucose range of 140–180 mg/dL in most hospitalized patients. Insulin is first-line therapy for hyperglycemia as it is adaptable to the changing patient physiology over the course of hospitalization. Critically ill patients should receive intravenous (IV) insulin infusion, and all non-critically ill patients with hyperglycemia should be managed using a subcutaneous (SC) insulin algorithm with basal, nutritional, and correctional dose components. The limiting factor to achieving a near euglycemic state is hypoglycemia. Similar to hyperglycemia, hypoglycemia is an independent risk factor for poor outcomes in the hospitalized patient. Institutions can increase safe insulin use by utilizing insulin algorithms, pre-printed order sets, and hypoglycemia protocols as well as by supporting patient and health care provider education. * IV : intravenous SC : subcutaneous ICU : intensive care unit BG : blood glucose AMI : acute myocardial infarction CAP : community-acquired pneumonia COPD : chronic obstructive pulmonary disease NICE-SUGAR : Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation AACE : American Association of Clinical Endocrinologists ADA : American Diabetes Association OADs : oral antidiabetic drugs GLP-1 : glucagon-like peptide 1 SHM : Society of Hospital Medicine TDD : total daily dose SSI : sliding-scale insulin HbA1C : hemoglobin A1c JCAHO : Joint Commission on Accreditation of Healthcare Organizations TPN : total parenteral nutrition EMR : electronic medical record POCT : point-of-care glucose testing
Databáze: OpenAIRE
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