Abstract:
Diabetes mellitus is currently approaching epidemic proportions and disproportionately affects patients in the hospital setting. In the United States, individuals living with diabetes represent over 17 million emergency department visits and 8 million admissions annually. The management of these patients in the hospital setting is complex and differs considerably from the outpatient setting. All patients with hyperglycemia should be screened for diabetes, as in-hospital hyperglycemia portends a greater risk for morbidity, mortality, admission to an intensive care unit, and increased hospital length of stay. However, the definition of hyperglycemia, glycemic targets, and strategies to manage hyperglycemia in the inpatient setting can vary greatly depending on the population considered. Moreover, the presenting illness, changing nutritional status, and concurrent hospital medications often necessitate thoughtful consideration to adjustments of home diabetes regimens and/or the initiation of new insulin doses. This review article will examine core concepts and emerging new literature surrounding inpatient diabetes management, including glycemic targets, insulin dosing strategies, noninsulin medications, new diabetes technologies, inpatient diabetes management teams, and discharge planning strategies, to optimize patient safety and satisfaction, clinical outcomes, and even hospital financial health.
摘要:
糖尿病目前正在接近流行病的比例,并不成比例地影响医院环境中的患者。在美国,患有糖尿病的人每年有超过1700万急诊就诊和800万入院。这些患者在医院环境中的管理是复杂的,并且与门诊环境有很大不同。所有高血糖患者都应进行糖尿病筛查,由于院内高血糖预示着更大的发病风险,死亡率,入住重症监护室,增加住院时间。然而,高血糖的定义,血糖目标,在住院患者中控制高血糖的策略可能因考虑的人群而异。此外,呈现的疾病,改变营养状况,和同时住院的药物治疗通常需要考虑调整家庭糖尿病治疗方案和/或开始新的胰岛素剂量。这篇综述文章将研究围绕住院糖尿病管理的核心概念和新兴的新文献,包括血糖目标,胰岛素给药策略,非胰岛素药物,糖尿病新技术,住院糖尿病管理团队,和出院计划策略,优化患者安全和满意度,临床结果,甚至医院的财务健康。