Managing Diabetes and Hyperglycemia in the Hospital: Critically Ill and Surgical Patients-References

References

Pdf Summary

This document compiles comprehensive references (2001-2023) on managing diabetes and hyperglycemia in hospitalized critically ill and surgical patients. It covers guidelines, clinical trials, meta-analyses, and practice recommendations addressing inpatient glucose control strategies.<br /><br />Key topics include the evolution of intensive insulin therapy in ICUs, starting with seminal studies by Van den Berghe et al. demonstrating benefits of tight glucose control, followed by subsequent trials (e.g., NICE-SUGAR) and meta-analyses revealing risks of hypoglycemia and mortality with overly strict targets. The balance of glucose control intensity remains a clinical debate.<br /><br />Perioperative glycemic management is addressed extensively, with evidence linking poor intraoperative and postoperative glucose control to increased infections, cardiovascular events, and mortality in cardiac and vascular surgeries. Practice guidelines from the American College of Physicians, Society of Thoracic Surgeons, and others recommend tailored insulin protocols, emphasizing continuous insulin infusions during cardiac surgery to improve outcomes.<br /><br />Innovative therapies such as glucagon-like peptide-1 (GLP-1) infusions are also highlighted for potentially improving glycemic control and cardiac function in surgical patients with type 2 diabetes.<br /><br />Practical inpatient management is reviewed, detailing transition protocols from intravenous insulin infusions to subcutaneous regimens, insulin pharmacokinetics, and multidisciplinary approaches to maintain glycemic stability post-ICU or surgery.<br /><br />Major diabetes organizations including the American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE) provide evidence-based standards of care reflecting updated consensus for inpatient glycemic targets, insulin use, and comprehensive diabetes management plans in hospitals.<br /><br />Overall, the references collectively emphasize individualized glucose control strategies balancing the benefits of avoiding hyperglycemia-related complications against the dangers of hypoglycemia, with a focus on surgical and critically ill patient populations to optimize safety and outcomes.

Keywords

diabetes management

hyperglycemia

critically ill patients

surgical patients

intensive insulin therapy

perioperative glycemic control

GLP-1 infusions

inpatient glucose control

insulin protocols

American Diabetes Association guidelines