American College of Endocrinology and American Diabetes Association Consensus Statement on Inpatient Diabetes and Glycemic Control

D iabetes has reached epidemic proportions in the U.S., affecting in excess of 20 million individuals (more than one of every three persons). In addition, another 26% have impaired fasting glucose (1). Similarly, a disproportionate number of hospitalized patients have diabetes. Furthermore, for every two patients in the hospital with known diabetes, there may be an additional patient with newly observed hyperglycemia (2,3). Compelling evidence continues to accumulate to suggest that poorly controlled blood glucose levels are associated with increased morbidity and mortality, as well as with higher health care costs. In 2002, 4.9 million hospital discharges in the U.S. were associated with diabetes (4). The cost of inpatient diabetes care for 2002 was estimated at $40 billion—the single largest component of direct medical costs for the disease (5). Until recently, glycemic control in hospitalized patients has not been a major therapeutic focus, partly because of a lack of published targets and guidelines for management of such patients and partly because evidence demonstrating improved overall outcomes as the result of improved glycemic control was only just emerging. In 2004, the American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologis ts (AACE) publ ished the first recommendations for the management of inpatient diabetes and metabolic control (6). The American Diabetes Association (ADA) supported an extensive technical review evaluating the relationships between glycemic control and its effect on hospital outcomes (7). This review became the basis for the 2005 ADA Clinical Practice Recommendations (8). Notwithstanding national and local efforts, widespread implementation of improved glycemic control for inpatients has remained an elusive goal for many medical centers. Multiple institutional and attitudinal obstacles still exist to improving health care, and these barriers have created a substantial and growing gap between what we know and what we actually do. For this reason, ACE and ADA joined forces and convened a consensus conference (Inpatient Diabetes and Glycemic Control: A Call to Action Conference), with the goal of identifying strategies to overcome barriers and facilitate improvements in inpatient diabetes care.