The Case for Improved Control Among Non-Diabetics

In the last several decades, an increasing number of stud-ies have examined hyperglycemia during hospitalization and the negative effects on outcomes. Most studies have fo-cused on hyperglycemia in patients who are diabetic and its impact on conditions for which these patients are at high risk, including cardiovascular disease1-5 and infection.6-8 In general, trials have reported significant benefit to reduce morbidity, mortality, length of stay, and healthcare re-source utilization with improved diabetic care, including tighter glucose control.9 However, increases in blood glucose levels among acutely ill non-diabetic patients have been witnessed for decades.10 Recently, more in-depth assessment of hyper-glycemia has occurred for at least 2 reasons. One is that the incidence of diabetes is rapidly increasing. By the year 2030, the number of diabetes cases is expected to double to 366 million people worldwide.11 Further, diabetes can go undetected and untreated for years. In the US, 5.3 mil-lion people are estimated to have undiagnosed diabetes. One study estimated that 50 % of patients with diabetes are undiagnosed and unaware of their disease.12 Thus, there is a high likelihood that many hyperglycemic patients pre-senting to the hospital may be undiagnosed or pre-diabet-Hyperglycemia in the Hospital Setting