J Clin Outcomes Manage
2007 May ;14(5):249-258
A diabetes management service to improve inpatient glycemic control
Fajtova VT, Anthony SG, McGurk S, McCarthy R, Homer D, Griffin L, Rawn J
Abstract Objective: To describe the development and implementation of a hospital diabetes management service. Methods: Review of the literature and account of the activities of the service and system changes implemented. Results: There is ample evidence that glycemic control is important for all patients in the acute care setting. It is probable that safe and effective targets will vary with the patientís acuity, diagnoses, and clinical setting. Tight control is probably most appropriate for the sickest patients in critical care settings; conversely, healthier patients in less acute settings should probably have less aggressive targets that minimize risk of hypoglycemia. Achieving glycemic control in the hospital is possible with the use of IV insulin infusions guided by frequent blood glucose monitoring, and by using subcutaneous insulin and insulin analogues. An IV insulin protocol has been shown to be safer and more effective than ad-lib titration of IV insulin. Conclusion: The ideal method for glucose control will depend on the clinical setting, anticipated nutritional intake, and the ability to monitor glucose levels and adjust the insulin regimen as clinical conditions change. Continued studies are needed to determine appropriate and specific glycemic control goals and the optimal protocols for achieving them.
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