Management of diabetes in the hospital

Hyperglycemia is a common complication in hospitalized patients, particularly among patients with acute myocardial infarction. It is an independent predictor of cardiovascular mortality and morbidity. Management of hyperglycemia with intensive insulin therapy has been shown to improve survival, reduce length of stay in intensive care, and decrease complications such as renal failure or prolonged mechanical ventilation in critically ill patients. Insulin infusions are now recommended for the treatment of hyperglycemia in several groups of patients, including patients in the intensive care unit and those undergoing major surgery. Implementation of protocols and standard orders may be useful to ensure the optimal use of insulin in the management of hyperglycemia. Fewer data are available to guide the management of hyperglycemia outside the intensive care setting. A variety of subcutaneous insulin regimens are now available with different pharmacokinetic profiles. These agents are preferred to controlling blood sugar with sliding scale regimens alone. Oral therapies may also have a role, but many agents may be contraindicated in the acute setting. As hyperglycemia has been shown to have significant adverse impact on patient outcomes in a variety of settings, cardiologists need to play a role in efforts to achieve adequate glycemic control in hospitalized patients with hyperglycemia in an effort to improve patient outcomes.