My patient is just a little too sweet…

According to a recent article published in , “Diabetes Under Control; Improving Hospital Care for Patients with Diabetes,” “The American Diabetes Association estimates that people with diabetes account for 22 percent of hospitalization days, and in 2007, their hospital care accounted for an estimated half of the $174 billion spent on diabetes care in the United States.” These statistics are staggering; nevertheless, if you consider the number of individuals diagnosed with diabetes, they usually are not surprising. We see patients with hyperglycemia each day, a few of whom are diabetic and a few of whom usually are not. The article points out that hyperglycemia within the acute care setting can indicate a diagnosis of diabetes, undiagnosed diabetes or prediabetes, or transient stress hyperglycemia, which may end up from the stress of illness. As everyone knows, a fingerstick blood glucose reading is a snapshot in time. It is on no account indicative of a patient’s glycemic control.

Hemoglobin A1C gives doctors a more accurate picture of a patient’s glycemic control over the past 60 to 90 days. In people without diabetes, A1C is about 5%. The American Diabetes Association recommends that diabetics have an A1C of seven% or less as a goal for good glycemic control. So why is A1C a vital lab value in acute care? Studies have shown that patients who maintain glycemic control have higher outcomes than those that don’t. Knowing A1C will show you how to manage your patient’s glycemia more effectively and efficiently and might help with discharge planning. Studies have shown which you can’t maintain glycemic control in diabetics by utilizing only short-acting insulin to cover meals. The patient must take an oral medication or long-acting insulin along with short-acting insulin.

Does your facility have a policy for detecting elevated blood glucose levels in all hospitalized patients, not only those diagnosed with diabetes? Does your standard of care include controlling hyperglycemia in all patients? For more information on implementing this standard in your hospital, read the June issue of AJN, “Diabetes Under Control, Improving Hospital Care for Patients with Diabetes.”