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Management of Patients with Type 1 Diabetes in the Hospital

  • Hospital Management of Diabetes (G Umpierrez, Section Editor)
  • Published:
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Abstract

Managing a patient with type 1 diabetes mellitus can be challenging to the inpatient medical team. These patients require a continuous supply of exogenous insulin, and the omission of even a single dose can result in severe hyperglycemia and diabetic ketoacidosis. This article aims to equip the inpatient medical team with the knowledge and expertise required to care for these patients in the hospital, including transitioning from home to hospital, transitioning from the intravenous insulin infusion to the subcutaneous route, subcutaneous insulin dosing including the insulin pump, and transitioning back to home.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Daneman D. Type 1 diabetes. Lancet. 2006;367:847–58.

    Article  CAS  PubMed  Google Scholar 

  2. Onkamo P, Väänänen S, Karvonen M, Tuomilehto J. Worldwide increase in incidence of Type I diabetes—the analysis of the data on published incidence trends. Diabetologia. 1999;42:1395–403.

    Article  CAS  PubMed  Google Scholar 

  3. Devendra D, Liu E, Eisenbarth GS. Type 1 diabetes: recent developments. BMJ. 2004;328:750–4.

    Article  PubMed  Google Scholar 

  4. Lambert AP, Gillespie KM, Thomson G, et al. Absolute risk of childhood-onset type 1 diabetes defined by human leukocyte antigen class II genotype: a population-based study in the United Kingdom. J Clin Endocrinol Metab. 2004;89:4037–43.

    Article  CAS  PubMed  Google Scholar 

  5. Umpierrez GE, Isaacs SD, Bazargan N, You X, et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87:978–82.

    CAS  PubMed  Google Scholar 

  6. Zerr KJ, Furnary AP, Grunkemeier GL, et al. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63:356–61.

    Article  CAS  PubMed  Google Scholar 

  7. Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003;78:1471–8.

    Article  PubMed  Google Scholar 

  8. Williams LS, Rotich J, Qi R, Fineberg N, et al. Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke. Neurology. 2002;59:67–71.

    Article  CAS  PubMed  Google Scholar 

  9. Falciglia M, Freyberg RW, Almenoff PL, et al. Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Critical Care Med. 2009;37:3001–9.

    Article  CAS  Google Scholar 

  10. Tewari S, Kathuria A, Meier-Kriesche H-U, et al. Association between admission hyperglycemia and length of stay after renal transplantation. Endocr Pract. 2010;16:805–9.

    Article  PubMed  Google Scholar 

  11. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. New Engl J Med. 1993;329:977–86.

  12. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. New Engl J Med. 2001;345:1359–67.

    Article  PubMed  Google Scholar 

  13. Malmberg K, Rydén L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol. 1995;26:57–65.

    Article  CAS  PubMed  Google Scholar 

  14. Umpierrez GE, Smiley D, Jacobs S, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diab Care. 2011;34:256–61. Important paper on basal bolus insulin therapy.

    Article  CAS  Google Scholar 

  15. Shogbon AO, Levy SB. Intensive glucose control in the management of diabetes mellitus and inpatient hyperglycemia. Am J Health Syst Pharm. 2010;67:798–805.

    Article  CAS  PubMed  Google Scholar 

  16. Jacobsen IB, Henriksen JE, Hother-Nielsen O, et al. Evidence-based insulin treatment in type 1 diabetes mellitus. Diabetes Res Clin Pract. 2009;86:1–10.

    Article  CAS  PubMed  Google Scholar 

  17. Standards of medical care in diabetes—2013. American Diabetes Association. Diab Care. 2013;36(Suppl 1):S11–66.

    Google Scholar 

  18. Vella S, Buetow L, Royle P, et al. The use of metformin in type 1 diabetes: a systematic review of efficacy. Diabetologia. 2010;53:809–20.

    Article  CAS  PubMed  Google Scholar 

  19. Wu P, Inskeep K, Bowker-Kinley MM, Popov KM, et al. Mechanism responsible for inactivation of skeletal muscle pyruvate dehydrogenase complex in starvation and diabetes. Diabetes. 1999;48:1593–9.

    Article  CAS  PubMed  Google Scholar 

  20. Pang TTL, Narendran P. Addressing insulin resistance in Type 1 diabetes. Diabetic Med. 2008;25:1015–24.

    Article  CAS  PubMed  Google Scholar 

  21. Beales PE, Pozzilli P. Thiazolidinediones for the prevention of diabetes in the non-obese diabetic (NOD) mouse: implications for human type 1 diabetes. Diabetes Metab Res Rev. 2002;18:114–7.

    Article  CAS  PubMed  Google Scholar 

  22. Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97:16–38.

    Article  CAS  PubMed  Google Scholar 

  23. Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009;15:353–69.

    Article  PubMed  Google Scholar 

  24. Clement S, Braithwaite SS, Magee MF, Ahmann A, et al. Management of diabetes and hyperglycemia in hospitals. Diab Care. 2004;27:553–91.

    Article  Google Scholar 

  25. American College of Endocrinology and American Diabetes Association consensus statement on inpatient diabetes and glycemic control. Endocr Pract. 2006;12:458–68.

    Google Scholar 

  26. Dates R, Origin DO. Medical policy No. 91516-R5. Medical errors: serious reportable events. 2006;91516:1–13.

  27. Vann MA. Perioperative management of ambulatory surgical patients with diabetes mellitus. Curr Opin Anesth. 2009;22:718–24.

    Article  Google Scholar 

  28. Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. Diab Care. 2009;32:1335–43. Important paper describing the presentation, pathogenesis, diagnosis, and management of DKA.

    Article  CAS  Google Scholar 

  29. Beck RW, Tamborlane WV, Bergenstal RM, et al. The T1D Exchange clinic registry. J Clin Endocrinol Metab. 2012;97:4383–9.

    Article  CAS  PubMed  Google Scholar 

  30. Pickup JC. Insulin-pump therapy for type 1 diabetes mellitus. New Engl J Med. 2012;366:1616–24. Important paper on insulin pump therapy in T1DM.

    Article  CAS  PubMed  Google Scholar 

  31. Grunberger G, Bailey TS, Cohen AJ, et al. Statement by the American Association of Clinical Endocrinologists Consensus Panel on insulin pump management. Endocr Pract. 2010;16:746–62.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Divya Yogi-Morren declares that she has no conflict of interest. M. Cecilia Lansang serves on the advisory board and receives honoraria from Sanofi.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Endocrinology, Cleveland Clinic Foundation, Cleveland Clinic Main Campus, Mail Code F20, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Divya Yogi-Morren & M. Cecilia Lansang

Authors
  1. Divya Yogi-Morren
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  2. M. Cecilia Lansang
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Corresponding author

Correspondence to M. Cecilia Lansang.

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This article is part of the Topical Collection on Hospital Management of Diabetes

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Yogi-Morren, D., Lansang, M.C. Management of Patients with Type 1 Diabetes in the Hospital. Curr Diab Rep 14, 458 (2014). https://doi.org/10.1007/s11892-013-0458-9

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  • DOI: https://doi.org/10.1007/s11892-013-0458-9

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