| Intensive glucose control in the management of diabetes mellitus and inpatient hyperglycemia. | |
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MedLine Citation:
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PMID: 20479101 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: The current evidence on intensive glycemic control in the inpatient and outpatient settings and its implications to practice are reviewed. SUMMARY: Poor glycemic control in patients with diabetes is associated with microvascular and macrovascular complications. Various clinical trials involving patients with type 1 and type 2 diabetes have revealed the benefits of intensive glycemic control in delaying the onset and progression of microvascular complications of diabetes. However, while long-term epidemiologic trials and a meta-analysis have shown a benefit of intensive glycemic control in reducing the incidence of macrovascular complications, recent clinical trials have not found similar benefits. The American Diabetes Association (ADA), American College of Endocrinology (ACE), and American Association of Clinical Endocrinologists recommend intensive control of glycosylated hemoglobin and plasma glucose at specified goals. Hyperglycemia in the inpatient setting is associated with increased morbidity and mortality. ACE and ADA recommend the use of an i.v. insulin infusion in critically ill inpatients with hyperglycemia. In noncritically ill inpatients, basal and bolus doses of insulin are recommended. The use of sliding-scale insulin as the sole therapy for inpatient hyperglycemia is discouraged. However, caution must be exercised to ensure a balance between controlling hyperglycemia and reducing the risk of hypoglycemia. CONCLUSION: While intensive glycemic control is known to prevent or delay the occurrence of microvascular complications of diabetes, macrovascular benefits are still uncertain. Current evidence suggests that intensive glycemic control should be initiated as soon as possible after diagnosis of type 1 or type 2 diabetes in order to maximize potential long-term macrovascular benefits. Inpatient hyperglycemia should be managed appropriately to reduce morbidity and mortality, with great care taken to avoid and appropriately treat hypoglycemia. |
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Authors:
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Angela O Shogbon; Steven B Levy |
Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists Volume: 67 ISSN: 1535-2900 ISO Abbreviation: Am J Health Syst Pharm Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-18 Completed Date: 2010-08-30 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9503023 Medline TA: Am J Health Syst Pharm Country: United States |
Other Details:
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Languages: eng Pagination: 798-805 Citation Subset: IM |
Affiliation:
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College of Pharmacy and Health Sciences, Mercer University, Atlanta, GA 30341, USA. shogbon_ao@mercer.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Clinical Trials as Topic Diabetes Complications / drug therapy Diabetes Mellitus, Type 1 / complications, drug therapy* Diabetes Mellitus, Type 2 / complications, drug therapy* Diabetic Angiopathies / prevention & control* Epidemiologic Studies Hemoglobin A, Glycosylated / drug effects Humans Hyperglycemia / complications, drug therapy* Infusions, Intravenous Insulin / administration & dosage* Practice Guidelines as Topic |
| Chemical | |
Reg. No./Substance:
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0/Hemoglobin A, Glycosylated; 11061-68-0/Insulin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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