According to a recent article published in the American Journal of Nursing, "Diabetes under control; improving hospital care for patients with diabetes", "the American Diabetes Association estimates that people with diabetes account for 22% of hospital inpatient days, and in 2007 their in-hospital care accounted for an estimated half of the $174 billion spent in the United States on diabetes care." These statistics are staggering; however, when you consider the number of people diagnosed with diabetes, they are not surprising. Every day we manage patients with hyperglycemia, some are diabetics and some are not. The article in AJN points out that hyperglycemia in the acute care setting can be indicative of a diagnosis of diabetes, undiagnosed diabetes or prediabetes, or transient stress hyperglycemia, which can result from the stress of illness. As we all know, a fingerstick glucose reading is a snap-shot in time of the blood glucose. In no way is it indicative of the glycemic control of the patient.
Hemoglobin A1C gives clinicians a more accurate picture of the patient's blood glucose control over the past 60 to 90 days. In people without diabetes, the A1C is around 5%. The American Diabetes Association recommends that diabetics have an A1C of 7% or less as a goal for good glycemic control. So why is the A1C an important lab value in acute care? Research has shown that patients who maintain glycemic control have better outcomes than those who don't. Knowing the A1C will help you manage the patient's blood glucose more effectively and efficiently and can aid in discharge planning. Research has shown you can't maintain glycemic control in diabetics by just using short acting insulin to cover meals. The patient must have an oral agent or a long acting insulin in addition to the short acting insulin.
Does your institution have a policy to to identify elevated blood glucose in all hospitalized patients, not just the ones who have the diagnosis of diabetes? Is your standard of care to control hyperglycemia in all patients? If you want more information on how to implement this standard at your hospital, read the June issue of AJN, "Diabetes under control, improivng hospital care for patients with diabetes".