Diabetes Care, Vol 21, Issue 2 246-249, Copyright © 1998 by American Diabetes Association

ARTICLES

Unrecognized diabetes among hospitalized patients

CS Levetan, M Passaro, K Jablonski, M Kass and RE Ratner
Medlantic Research Institute, Washington, DC 20003, USA.

OBJECTIVE: To evaluate the hospital care rendered to hyperglycemic individuals who did not have a diagnosis of diabetes before admission. RESEARCH DESIGN AND METHODS: A total of 1,034 consecutively hospitalized adult patients at a 750-bed inner-city teaching hospital were evaluated. Patients with one or more plasma glucose values > 200 mg/dl were identified by the laboratory data system on a daily basis. Patients without a diagnosis of diabetes at the time of admission were evaluated to determine if and how physicians addressed the hyperglycemia, whether a new diagnosis of diabetes was made during admission, and whether follow-up was planned to address the hyperglycemia. RESULTS: After excluding patients who were admitted for a primary diagnosis of diabetes, 37.5% of all hyperglycemic medical patients and 33% of hyperglycemic surgical patients were without a diagnosis of diabetes at the time of admission. These patients had a mean peak glucose of 299 mg/dl, and 66% had two or more elevated values during their hospitalization. Fifty-four percent received insulin therapy, and 59% received bedside glucose monitoring, yet 66% of daily patient progress notes failed to comment on the presence of hyperglycemia or diabetes. Diabetes was documented in only three patients (7.3%) as a possible diagnosis in the daily progress notes. CONCLUSIONS: Despite marked hyperglycemia, most medical records made no reference to the possibility of unrecognized diabetes. Given the average delay of a decade between the onset and diagnosis of type 2 diabetes, further evaluation of hyperglycemic hospitalized patients may present an important opportunity for earlier detection and the initiation of therapy.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				D. J. Wexler, D. M. Nathan, R. W. Grant, S. Regan, A. L. Van Leuvan, and E. Cagliero Prevalence of Elevated Hemoglobin A1c among Patients Admitted to the Hospital without a Diagnosis of Diabetes J. Clin. Endocrinol. Metab., November 1, 2008; 93(11): 4238 - 4244. [Abstract] [Full Text] [PDF]

				M. C. Lansang and G. E. Umpierrez Management of Inpatient Hyperglycemia in Noncritically Ill Patients Diabetes Spectr, October 1, 2008; 21(4): 248 - 255. [Abstract] [Full Text] [PDF]

				S. Penfold, R. Gouni, P. Hamilton, T. Richardson, and D. Kerr Immediate in-patient management of hyperglycaemia--confusion rather than consensus? QJM, February 1, 2008; 101(2): 87 - 90. [Abstract] [Full Text] [PDF]

				C. B. Cook, K. A. Jameson, Z. C. Hartsell, M. E. Boyle, B. J. Leonhardi, M. Farquhar-Snow, and K. A. Beer Beliefs About Hospital Diabetes and Perceived Barriers to Glucose Management Among Inpatient Midlevel Practitioners The Diabetes Educator, January 1, 2008; 34(1): 75 - 83. [Abstract] [Full Text] [PDF]

				M. A. Malesker, P. A. Foral, A. C. McPhillips, K. J. Christensen, J. A. Chang, and D. E. Hilleman An Efficiency Evaluation of Protocols for Tight Glycemic Control in Intensive Care Units Am. J. Crit. Care., November 1, 2007; 16(6): 589 - 598. [Abstract] [Full Text] [PDF]

				K. Asadollahi, N. Beeching, and G. Gill Hyperglycaemia and mortality J R Soc Med, November 1, 2007; 100(11): 503 - 507. [Abstract] [Full Text] [PDF]

				G. E. Umpierrez, D. Smiley, A. Zisman, L. M. Prieto, A. Palacio, M. Ceron, A. Puig, and R. Mejia Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes (RABBIT 2 Trial) Diabetes Care, September 1, 2007; 30(9): 2181 - 2186. [Abstract] [Full Text] [PDF]

				R. K. Campbell Etiology and effect on outcomes of hyperglycemia in hospitalized patients Am. J. Health Syst. Pharm., May 15, 2007; 64(10_Supplement_6): S4 - S8. [Abstract] [Full Text] [PDF]

				E. Hassan Hyperglycemia management in the hospital setting Am. J. Health Syst. Pharm., May 15, 2007; 64(10_Supplement_6): S9 - S14. [Abstract] [Full Text] [PDF]

				L. S. Cohen, L. Sedhom, M. Salifu, and E. A. Friedman Inpatient Diabetes Management: Examining Morning Practice in an Acute Care Setting The Diabetes Educator, May 1, 2007; 33(3): 483 - 492. [Abstract] [Full Text] [PDF]

				M. C. Lansang and H. Harrell Knowledge on Inpatient Diabetes Among Fourth-Year Medical Students Diabetes Care, May 1, 2007; 30(5): 1088 - 1091. [Abstract] [Full Text] [PDF]

				D. J. Wexler, J. B. Meigs, E. Cagliero, D. M. Nathan, and R. W. Grant Prevalence of Hyper- and Hypoglycemia Among Inpatients With Diabetes: A national survey of 44 U.S. hospitals Diabetes Care, February 1, 2007; 30(2): 367 - 369. [Full Text] [PDF]

				The ACE/ADA Task Force on Inpatient Diabetes American College of Endocrinology and American Diabetes Association Consensus Statement on Inpatient Diabetes and Glycemic Control: A call to action Diabetes Care, August 1, 2006; 29(8): 1955 - 1962. [Full Text] [PDF]

				A. H. Lauruschkat, B. Arnrich, A. A. Albert, J. A. Walter, B. Amann, U. P. Rosendahl, T. Alexander, and J. Ennker Prevalence and Risks of Undiagnosed Diabetes Mellitus in Patients Undergoing Coronary Artery Bypass Grafting Circulation, October 18, 2005; 112(16): 2397 - 2402. [Abstract] [Full Text] [PDF]

				D. Baldwin, G. Villanueva, R. McNutt, and S. Bhatnagar Eliminating Inpatient Sliding-Scale Insulin: A reeducation project with medical house staff Diabetes Care, May 1, 2005; 28(5): 1008 - 1011. [Abstract] [Full Text] [PDF]

				W. D. Smith, A. G. Winterstein, T. Johns, E. Rosenberg, and B. C. Sauer Causes of hyperglycemia and hypoglycemia in adult inpatients Am. J. Health Syst. Pharm., April 1, 2005; 62(7): 714 - 719. [Abstract] [Full Text] [PDF]

				M. Bryer-Ash and A. J. Garber Point: Inpatient Glucose Management: The emperor finally has clothes Diabetes Care, April 1, 2005; 28(4): 973 - 975. [Full Text] [PDF]

				T. M Conner, K. R Flesner-Gurley, and J. C Barner Hyperglycemia in the Hospital Setting: The Case for Improved Control Among Non-Diabetics Ann. Pharmacother., March 1, 2005; 39(3): 492 - 501. [Abstract] [Full Text] [PDF]

				A. T. Nettles Patient Education in the Hospital Diabetes Spectr, January 1, 2005; 18(1): 44 - 48. [Abstract] [Full Text] [PDF]

				A. G. Pittas, R. D. Siegel, and J. Lau Insulin Therapy for Critically Ill Hospitalized Patients: A Meta-analysis of Randomized Controlled Trials Arch Intern Med, October 11, 2004; 164(18): 2005 - 2011. [Abstract] [Full Text] [PDF]

				G. Olveira-Fuster, P. Olvera-Marquez, F. Carral-Sanlaureano, S. Gonzalez-Romero, M. Aguilar-Diosdado, and F. Soriguer-Escofet Excess Hospitalizations, Hospital Days, and Inpatient Costs Among People With Diabetes in Andalusia, Spain Diabetes Care, August 1, 2004; 27(8): 1904 - 1909. [Abstract] [Full Text] [PDF]

				Z. T. Bloomgarden Inpatient Diabetes Control: Rationale Diabetes Care, August 1, 2004; 27(8): 2074 - 2080. [Full Text] [PDF]

				S. Clement, S. S. Braithwaite, M. F. Magee, A. Ahmann, E. P. Smith, R. G. Schafer, and I. B. Hirsch Management of Diabetes and Hyperglycemia in Hospitals Diabetes Care, February 1, 2004; 27(2): 553 - 591. [Full Text] [PDF]

				K. Martin, L. Carter, D. Ballunas, F. Sotoudeh, D. Moore, and J. Westerflield The Impact of Verbal Communication on Physician Prescribing Patterns in Hospitalized Patients With Diabetes The Diabetes Educator, September 1, 2003; 29(5): 827 - 836. [Abstract] [PDF]

				D.M. Bravata, N. Kim, J. Concato, and L.M. Brass Hyperglycaemia in patients with acute ischaemic stroke: how often do we screen for undiagnosed diabetes? QJM, July 1, 2003; 96(7): 491 - 497. [Abstract] [Full Text] [PDF]

				L. S. Greci, M. Kailasam, S. Malkani, D. L. Katz, I. Hulinsky, R. Ahmadi, and H. Nawaz Utility of HbA1c Levels for Diabetes Case Finding in Hospitalized Patients With Hyperglycemia Diabetes Care, April 1, 2003; 26(4): 1064 - 1068. [Abstract] [Full Text] [PDF]

				R. R. McCandless Attributing Inpatient Medicare Costs to Diabetes Among the Texas Elderly Diabetes Care, November 1, 2002; 25(11): 1958 - 1963. [Abstract] [Full Text] [PDF]

				L. S. Williams, J. Rotich, R. Qi, N. Fineberg, A. Espay, A. Bruno, S. E. Fineberg, and W. R. Tierney Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke Neurology, July 9, 2002; 59(1): 67 - 71. [Abstract] [Full Text] [PDF]

				S. Smith Several simple rules predicted complications in high risk patients with diabetes Evid. Based Med., May 1, 2002; 7(3): 96 - 96. [Full Text] [PDF]

				I. B. Hirsch In-Patient Hyperglycemia--Are We Ready to Treat It Yet? J. Clin. Endocrinol. Metab., March 1, 2002; 87(3): 975 - 977. [Full Text] [PDF]

				G. E. Umpierrez, S. D. Isaacs, N. Bazargan, X. You, L. M. Thaler, and A. E. Kitabchi Hyperglycemia: An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes J. Clin. Endocrinol. Metab., March 1, 2002; 87(3): 978 - 982. [Abstract] [Full Text] [PDF]

				C. Levetan and M. Sharma Case Study: The Recipe for Diabetes Success in the Hospital Diabetes Spectr, January 1, 2002; 15(1): 40 - 43. [Full Text] [PDF]

				J. B. BOORD, A. L. GRABER, J. W. CHRISTMAN, and A. C. POWERS Practical Management of Diabetes in Critically Ill Patients Am. J. Respir. Crit. Care Med., November 15, 2001; 164(10): 1763 - 1767. [Full Text] [PDF]

				C. L. Marshall, M. Bluestein, E. Briere, C. Chapin, B. Darling, K. Davis, T. Davis, J. Gersten, C. Harris, A. Hodgin, et al. Improving Outpatient Diabetes Management Through a Collaboration of Six Competing, Capitated Medicare Managed Care Plans American Journal of Medical Quality, March 1, 2000; 15(2): 65 - 71. [Abstract] [PDF]

				F. Vinicor When Is Diabetes Diabetes? JAMA, April 7, 1999; 281(13): 1222 - 1224. [Full Text] [PDF]