- July 21, 2015
In hospitalized patients, managing blood glucose levels is a complex and sometimes controversial issue. For about 20 percent of the hospitalized population, hyperglycemia (excess blood sugar) has a significant detrimental impact, which includes increased mortality. This also correlates with increased morbidity, negative outcomes, increased length of stay in the ICU and in the hospital. Additionally, it is associated with higher infection rates and more ventilator days.
The management of glucose levels is a concern for diabetic patients in the hospital, just as it is elsewhere. Some hospitalized patients suffer hyperglycemia due to previously undetected diabetes that surfaces in a more exaggerated form due to illness. However, people undergoing medical treatment for a wide variety of illnesses frequently develop hyperglycemia due to the metabolic stress of illness, nutritional changes, and certain drug therapies. In fact, statistics indicate that 46% of patients in the ICU are hyperglycemic.
Just what are the optimal blood glucose levels for the critically ill patient? While recommendations are changing over the years, this is a hotly debated topic. Some choose tight control of 90 to 120 mg/dL, while conventional levels of 140 to 180 mg/dL are advocated by others. Study results focusing on the two approaches are conflicting.
Glucose is typically controlled with intravenous insulin infusion, and one aspect of this control is the costly and labor-intensive process with initial patient monitoring every 30 to 60 minutes. Today, commonly used pre-printed insulin scales and orders based on generalized algorithms are extremely imprecise. As a result, patients often swing back and forth between hyperglycemia and hypoglycemia. Significant evidence exists that these severe fluctuations in blood sugar levels in and of themselves can have a negative impact.
Not only is the patient outcome a priority, but financial incentives make glucose a main concern. According to The Centers for Medicare and Medicaid Services, complications arising from suboptimal blood glucose levels are viewed as a “Hospital-Acquired Condition” whose treatment is an additional expense. Minimizing the length of stay in the ICU and hospital overall reduces costs, decreases infections and other complications as part of a glycemic management program.