ABSTRACT
Adults with diabetes mellitus are admitted to the hospital more frequently than nondiabetics, often for prolonged periods. Particularly common are admissions for hyperglycemic emergencies, local or systemic infections, unstable angina or myocardial infarction, stroke, and orthopedic injuries. One would hope that hospitalization would be a time to reinforce the principles of optimal diabetes care. Instead, glycemic control in the inpatient setting, especially in insulin-treated patients, is often unsuccessful. There are many reasons for this, some relating to glycemic effects of the underlying illness or the pharmaceuticals used to treat it; dietary changes are also a factor. More troubling is that hospital staffs are often poorly trained in insulin usage-‘‘sliding-scale’’ regimens are still standard medical practice despite the fact that they rarely allow stable glycemia even under ideal medical conditions (1). Further, there remains no consensus as to what constitutes optimal glycemic care for the inpatient. The past few years have seen the publication of many important studies proving the importance of rigorous outpatient glycemic control for the prevention of microvascular complications. In contrast, there is very little literature supporting benefits of aggressive gly-
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cemic control for inpatients in terms of lowered morbidity, mortality, or shorter hospitalization time. Rather, many practitioners consider prevention of hypoglycemia the dominant goal for inpatients, and aim to not let the blood glucose fall below 200 mg/dl. Thus, the average practitioner is unclear about the importance, or method, for blood glucose management in the hospital.
