Management of Diabetes and Hyperglycemia in Hospitals

  1. Stephen Clement, MD, CDE1,
  2. Susan S. Braithwaite, MD2,
  3. Michelle F. Magee, MD, CDE3,
  4. Andrew Ahmann, MD4,
  5. Elizabeth P. Smith, RN, MS, CANP, CDE1,
  6. Rebecca G. Schafer, MS, RD, CDE5,
  7. Irl B. Hirsch, MD6 and
  8. on behalf of the Diabetes in Hospitals Writing Committee
  1. 1Georgetown University Hospital, Washington, DC
  2. 2University of North Carolina, Chapel Hill, North Carolina
  3. 3Medstar Research Institute at Washington Hospital Center, Washington, DC
  4. 4Oregon Health and Science University, Portland, Oregon
  5. 5VA Medical Center, Bay Pines, Florida
  6. 6University of Washington, Seattle, Washington
  1. Address correspondence and reprint requests to Dr. Stephen Clement, MD, Georgetown University Hospital, Department of Endocrinology, Bldg. D, Rm. 232, 4000 Reservoir Rd., NW, Washington, DC 20007. E-mail: clements{at}

Diabetes increases the risk for disorders that predispose individuals to hospitalization, including coronary artery, cerebrovascular and peripheral vascular disease, nephropathy, infection, and lower-extremity amputations. The management of diabetes in the hospital is generally considered secondary in importance compared with the condition that prompted admission. Recent studies (1,2) have focused attention to the possibility that hyperglycemia in the hospital is not necessarily a benign condition and that aggressive treatment of diabetes and hyperglycemia results in reduced mortality and morbidity. The purpose of this technical review is to evaluate the evidence relating to the management of hyperglycemia in hospitals, with particular focus on the issue of glycemic control and its possible impact on hospital outcomes. The scope of this review encompasses adult nonpregnant patients who do not have diabetic ketoacidosis or hyperglycemic crises.

For the purposes of this review, the following terms are defined (adapted from the American Diabetes Association [ADA] Expert Committee on the Diagnosis and Classification of Diabetes Mellitus) (3):

  • Medical history of diabetes: diabetes has been previously diagnosed and acknowledged by the patient’s treating physician.

  • Unrecognized diabetes: hyperglycemia (fasting blood glucose ≥126 mg/dl or random blood glucose ≥200 mg/dl) occurring during hospitalization and confirmed as diabetes after hospitalization by standard diagnostic criteria, but unrecognized as diabetes by the treating physician during hospitalization.

  • Hospital-related hyperglycemia: hyperglycemia (fasting blood glucose ≥126 mg/dl or random blood glucose ≥200 mg/dl) occurring during the hospitalization that reverts to normal after hospital discharge.

What is the prevalence of diabetes in hospitals?

The prevalence of diabetes in hospitalized adult patients is not known. In the year 2000, 12.4% of hospital discharges in the U.S. listed diabetes as a diagnosis. The average length of stay was 5.4 days (4). Diabetes was the principal diagnosis in only 8% of these hospitalizations. The accuracy of using hospital discharge diagnosis codes for identifying patients with …

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