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Treatment Intensification and Blood Glucose Control Among Hospitalized Diabetic Patients

  • Hospital Medicine
  • Published:
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Abstract

Background

Hyperglycemia is common among diabetic inpatients, and has been linked to adverse outcomes. However, antihyperglycemic treatment is seldom intensified in noncritical care patients, and the relationship between intensification frequency and glucose control is poorly understood. We evaluated the relationship between treatment intensification and changes in blood glucose in hospitalized diabetic patients.

Design

We retrospectively analyzed 3,613 hospitalized diabetic patients who were admitted to the hospital between January 2003 and August 2004, were not hospitalized in an ICU, were not prescribed IV insulin or total parenteral nutrition (TPN), had a length of stay of at least 3 days, and had at least one point-of-care blood glucose measurement. A linear model was used to assess the relationship between intensification of antihyperglycemic medications and the average daily change in point-of-care glucose measurements.

Results

Hyperglycemia (>180 mg/dL) was documented at least once for 82.5% of patient admissions. Antihyperglycemic treatment was intensified for 22.0% of days with hyperglycemia. Intensifications of scheduled and sliding scale insulin, but not oral medications, were associated with a 11.1 mg/dL (p < 0.0001) and 12.2 mg/dL (p < 0.0001) reduction in the average daily glucose, respectively. Hypoglycemia (<50 mg/dL) was documented on 2.2% of days after antihyperglycemic treatment intensification.

Conclusion

In this cohort, lack of treatment intensification in response to inpatient hyperglycemia was common. Antihyperglycemic treatment intensification was strongly associated with decrease in average daily glucose, while hypoglycemia was uncommon. This suggests that increasing the frequency of treatment intensifications could lead to improved glycemic control in inpatients with diabetes.

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Acknowledgments

This study was supported by grants from the Diabetes Trust Foundation (to AT), Diabetes Action Research and Education Foundation (to AT), and T15-LM-07092 from the National Library of Medicine (to MEM). The authors would like to thank Jennifer Rogala for her assistance extracting the CPOE orders from the inpatient medical record, and Shawn Murphy and the staff of the Laboratory of Computer Science (LCS) for the use of the RPDR.

Conflicts of Interest Statement

None disclosed.

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Corresponding author

Correspondence to Alexander Turchin MD, MS.

Additional information

Conference Abstract: American Diabetic Association 2007

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Matheny, M.E., Shubina, M., Kimmel, Z.M. et al. Treatment Intensification and Blood Glucose Control Among Hospitalized Diabetic Patients. J GEN INTERN MED 23, 184–189 (2008). https://doi.org/10.1007/s11606-007-0468-x

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  • DOI: https://doi.org/10.1007/s11606-007-0468-x

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