ABSTRACT
Diabetes is a common, although underreported, concurrent medical problem in many patients admitted to the hospital. The rate of hospitalization for persons with diabetes is about three times higher than the general population. Diabetes management is often unaggressive in the hospital and opportunities for education are missed. In addition, hyperglycemia is often unrecognized, untreated, and unrecorded in ill patients not known to have diabetes. Physicians should be wary of making the diagnosis of diabetes during the stress of hospitalization. The diagnostic criteria are based on ambulatory glucose values. However, given present concern about the role of chronic hyperglycemia in the development of diabetic complications, it is justifiable to view hospitalization as a metabolic stress test. Hyperglycemia in this setting certainly warrants correction and further outpatient evaluation. An elevated hemoglobin AiC (HgAlc) suggests a duration of hyperglycemia of at least 2 months. It is estimated that half the persons with diabetes are not aware that they have the disease. Often the diagnosis is made when severe complications have already developed. Identification of hyperglycemia during a hospital stay, even if glucose tolerance is normal at later testing, is an opportunity for intervention that should not be overlooked.
