|
 |
|
|||||||
|
|||||||||
Copyright © 2005 by American Society of Health-System Pharmacists
Reports |
Causes of hyperglycemia and hypoglycemia in adult inpatients
WENDY D. SMITH, PHARM.D., is Clinical Specialist in Drug Information, The Methodist Hospital, Houston, TX; at the time of this study she was Drug Information Specialty Resident, Shands Hospital at the University of Florida (SHUF), Gainesville. ALMUT G. WINTERSTEIN, PH.D., is Assistant Professor, Pharmacy Healthcare Administration, College of Pharmacy, University of Florida (UF), Gainesville. THOMAS JOHNS, PHARM.D., BCPS, is Manager of Clinical Practice Operations, SHUF. ERIC ROSENBERG, M.D., M.S.P.H., is Assistant Professor, Department of Medicine, College of Medicine, UF. BRIAN C. SAUER, PH.D., is Medical Informatics Fellow, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT; at the time of this study Dr. Sauer was a doctoral student, Department of Pharmacy Health Care Administration, College of Pharmacy, UF.
Address correspondence to Dr. Winterstein at Pharmacy Health-care Administration, College of Pharmacy, Health Science Center, University of Florida, P.O. Box 100496, Gainesville, FL 32610 (almut{at}ufl.edu).
Methods. Hyperglycemic and hypoglycemic events occurring in adult medical and surgical patients admitted between February and July 2003 to a tertiary care hospital were identified prospectively from automated daily printouts of abnormal blood glucose levels generated by the hospital laboratory. Information on the causes of a random sample of events was ascertained within 24 hours through chart review and provider and patient interviews. Narratives were presented to an expert committee to assess the causes of each event and preventability.
Results. Eighteen of 24 hypoglycemic events and 26 of 26 hyperglycemic episodes were considered preventable. Failure to adjust antidiabetic drugs in response to decreases in oral intake and unexpected deviation from normal hospital routine were the most common factors contributing to hypoglycemia. Hyperglycemia was most often associated with an unwillingness of providers to take responsibility for diabetes management and the exclusive use of sliding-scale insulin regimens.
Conclusion. Hyperglycemia and hypoglycemia in medical and surgical inpatients were mostly related to inadequate prescribing, monitoring, and communication practices.
Index terms: Antidiabetic agents; Communication; Diabetes mellitus; Dosage; Errors, medication; Hospitals; Hyperglycemia; Hypoglycemia; Insulin; Prescribing; Toxicity
Purpose. The underlying causes of hyperglycemia and hypoglycemia in adult medical and surgical inpatients were studied.
This article has been cited by other articles:
|
|
 |
|
  M. Pleva, J. M. Mirtallo, and S. M. Steinberg Hyperglycemic Events in Non-Intensive Care Unit Patients Receiving Parenteral Nutrition Nutr Clin Pract, October 1, 2009; 24(5): 626 - 634. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Uplinger, M. C. Turkel, P. C. Adams, D. Nelson-Slemmer, and S. Pierce Development of a DiaBEATes Nurse Champion Program The Diabetes Educator, September 1, 2009; 35(5): 713 - 726. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. S. Moghissi, M. T. Korytkowski, M. DiNardo, D. Einhorn, R. Hellman, I. B. Hirsch, S. E. Inzucchi, F. Ismail-Beigi, M. S. Kirkman, and G. E. Umpierrez American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control Diabetes Care, June 1, 2009; 32(6): 1119 - 1131. [Full Text] [PDF]
|
|
|
|
 |
|
 M Noschese, A C Donihi, G Koerbel, E Karslioglu, M Dinardo, M Curll, and M T Korytkowski Effect of a diabetes order set on glycaemic management and control in the hospital Qual. Saf. Health Care, December 1, 2008; 17(6): 464 - 468. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. A. Maynard, M. P. Huynh, and M. Renvall Iatrogenic Inpatient Hypoglycemia: Risk Factors, Treatment, and Prevention: Analysis of Current Practice at an Academic Medical Center With Implications for Improvement Efforts Diabetes Spectr, October 1, 2008; 21(4): 241 - 247. [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. M. Smith, K. E. Oveson, W. Strauss, K. Raven, M. C. Lefevre, A. J. Ahmann, and D. S. Hagg Ultradian Variation of Blood Glucose in Intensive Care Unit Patients Receiving Insulin Infusions Diabetes Care, October 1, 2007; 30(10): 2503 - 2505. [Full Text] [PDF]
|
|
|
|
|
|
M. Anthony Treatment of Hypoglycemia in Hospitalized Adults: A Descriptive Study The Diabetes Educator, July 1, 2007; 33(4): 709 - 715. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Derr, M. S. Sivanandy, L. Bronich-Hall, and A. Rodriguez Insulin-Related Knowledge Among Health Care Professionals in Internal Medicine Diabetes Spectr, July 1, 2007; 20(3): 177 - 185. [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]
|
|
|
|
|
|
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. S. Mathis and M. T. Liu Corticosteroids an important cause of hyperglycemia Am. J. Health Syst. Pharm., October 1, 2005; 62(19): 1976 - 1979. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |