Most physicians will encounter acutely ill patients who develop hyperglycemia.
A third of all persons admitted to an urban general hospital had fasting glucose
levels exceeding 126 mg/dL (7 mmol/L), or 2 or more random glucose levels
exceeding 200 mg/dL (11.1 mmol/L); a third of those patients with hyperglycemia
did not have a prior diagnosis of diabetes.1 Physicians
often perceive hyperglycemia as a consequence of stress that runs parallel
to the clinical course of an acute illness. Clinicians often start treatment
of hyperglycemia only after glucose levels have exceeded 200 to 250 mg/dL
(11-14 mmol/L). One reason for this is the perception that avoidance of hypoglycemia
and its potential consequences is more important than glycemic control while
patients are hospitalized. We discuss the evidence supporting the hyperglycemic
milieu as a risk factor for adverse outcomes in the acutely ill patient with
and without known diabetes, and we focus on the efficacy and safety of implementing
tighter glycemic control for hospitalized patients.
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