Management of Diabetes and Hyperglycemia in Hospitalized Patients

Diabetes is a prevalent metabolic disorder that affects more than 415 million people globally [1]. Globally, diabetes care has been estimated at $1.31trillion [2]. Further, according to the International Diabetes Federation, 1 in 10 adults will have diabetes by 2040 [1]. In the United States, data from the National Diabetes Statistics reported in 2012 that a total of 29.1 million Americans, or 9.3% of the population, had diabetes [3]. The percentage of the population with diagnosed diabetes is expected to rise, with one study projecting that as many as one in three U.S. adults will have diabetes by 2050 [4]. Patients with diabetes have a 3-fold greater chance of hospitalization compared to those without diabetes [5,6], and it is estimated that more than 20% of all adults discharged have diabetes, with 30% of them requiring 2 or more hospitalizations in any given year [5-7]. In 2012 in the U.S., there were over 7.7 million hospital stays for patients with diabetes (i.e., diabetes as either a principal diagnosis for hospitalization or as a secondary diagnosis, coexisting condition) and in the UK the 2016 National Diabetes Inpatient Audit suggested that the prevalence of diabetes amongst inpatients had risen from 15% in 2010 to 17% in 2016 [8]. In addition, patients hospitalized with a diagnosis of diabetes stay in the hospital for longer than those without a diagnosis of diabetes admitted for the same condition [9].Diabetes remains the 7th leading cause of death in the United States in 2014, with 76,488 death certificates listing it as the underlying cause of death, accouting for 24 deaths per 100,000 of the population [10]. The care of patients with diabetes imposes a substantial burden on the economy, with a total estimated cost of diagnosed diabetes in the United States in 2012 was $245 billion; including $176 billion in direct medical costs and $69 billion in reduced productivity [11]. The largest component of this medical expenditure is hospital inpatient care , accounting for 43% of the total medical cost [11].Hyperglycemia is defined as a blood glucose greater than 140 mg/dl (7.8 mmol/l) [12,13]. It is reported in 22% to 46% of non-critically ill hospitalized patients [7,12]. Extensive observational and trial data indicate that inpatient hyperglycemia, in patients with or without a prior diagnosis of diabetes, is associated with an increased risk of complications and mortality, a longer hospital stay, a higher admission rate to the intensive care unit (ICU), and a higher need for transitional or nursing home care after hospital discharge [7].