Hospital management of diabetes

An estimated six million annual hospitalizations are accompanied by hyperglycemia in the United States. There is a growing body of literature that strongly supports the concept that optimizing glycemic control in the hospital setting would result in improved outcomes. This article reviews the rationale and evidence for tight glycemic control, particularly among patients hospitalized for cardiac disease, stroke, infections, and surgical procedures. The authors give an overview of goals for control and the use of insulin in the hospital setting, and among inpatients with hyperglycemia in special circumstances. These circumstances include the settings of stroke, myocardial infarction and surgical procedures, including coronary artery bypass, enteral and parenteral nutritional therapy, and glucocorticoid therapy.