Literature Review - Table of Contents
I. Essential Guidelines and Reviews
ACE Position Statement and Consensus Conference Reviews
Garber AJ, Moghissi ES, Bransome ED Jr, et al. American College of Endocrinology Position Statement on Inpatient Diabetes and Metabolic Control. Endocr Pract. 2004;10 Suppl 2:4-9.
The American College of Endocrinology, American Association of Clinical Endocrinologists, and cosponsoring organizations (including SHM) outlined the evidence supporting inpatient glycemic control, and endorsed the need for early detection of hyperglycemia, and aggressive management to achieve glycemic targets.
The upper limits for glycemic targets:
• in the ICU setting: 110 mg/dL
• for non-critical care units: a preprandial glucose of 110 mg/dL, and a maximal glucose of 180 mg/dL.
ACE / ADA Inpatient Diabetes and Glycemic Control Consensus Statement
Garber A, Moghissi E, et al. American College of Endocrinology and American Diabetes Association Consensus statement on inpatient diabetes and glycemic control: a call to action. Diabetes Care. 2006 Aug;29(8):1955-62. also published in Endocrine Practice. 2006 July / Aug 12 (4) 458-68.
This recent conference updated an evidence review supporting inpatient glycemic control, and also outlined essential elements that institutions need to put successful glycemic control programs in place. These essential elements formed the core outline for the SHM Workbook to Optimize Glycemic Control and Reduce Hypoglycemia, which can be found here on the website.
ADA Technical Review
Clement S, Braithwaite SS, Magee MF et al; American Diabetes Association Diabetes in Hospitals Writing Committee. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27:553-91.
An indispensable review full of practical information, as well as a well articulated review of the literature on the topic. Insulin strategies for patients in special situations and with varied forms of nutritional intake are outlined, and policy / educational issues for institutions are also addressed.
ADA Standards for Diabetes
American Diabetes Association: Standards of Medical Care in Diabetes. Diabetes Care. 2006”29(Suppl. 1): S4-S42.
The standards for the special population of hospitalized patients is included. Recommendations for identifying, monitoring, educating, and treating the patient with hyperglycemia can be found here. Glycemic targets are defined similarly to the ACE targets:
• Critical Care: 110 mg/dL
• Non-critical Care: 90-130 mg/dL (midpoint 110 mg/dL) and random < 180 mg/dL.
Recommendation also made for A1C testing if none available in last 30-60 days.
ASHP Recommendations for Safe Use of Insulin in Hospitals
American Society of Health-System Pharmacists and the Hospital and Health-System Association of Pennsylvania: Recommendations for Safe Use of Insulin in Hospitals.
Accessed as a pdf at: http://www.ashp.org/emplibrary/Safe_Use_of_Insulin.pdf (November 13, 2006).
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II. Reviews and Insulin Infusion Protocols
Reviews
Insulin Infusion Protocols
See the review by Ahmann et al. in the Glycemic Control Workbook on Insulin infusion protocols. The descriptions of the protocols are taken from Dr. Ahmann's work which can be found there in more detail.
View the Insulin Infusion Protocols review in the Glycemic Control Workbook.
No patient left behind: Evaluation and design of intravenous insulin algorithms
Braithwaite, SSB Godara, H, Song, HJ et all. Endocrine Practice 2006:12 Supp 3:72-78.
Intravenous insulin infusion therapy: Indications, methods, and transition to subcutaneous insulin therapy
Bode BW, Braithwaite SS, Steed RD, Davidson PC. Endocrine Practice. 2004;10 Suppl 2:71-80.
Protocols
Description and evaluation of a glycemic management protocol for patients with diabetes undergoing heart surgery
Markovitz LJ, Wiechmann RJ, Harris N, et al. Endocr Pract. 2002; 8:10-18.
Used in cardiac surgery patients. The first published paper form of the “column method,” it used a higher goal than typically proposed today. It has been modified by many parties with adjustment of goals. Offers a specific infusion rate and directed sensitivity adjustments for nursing personnel.
The rationale and management of hyperglycemia for in-patients with cardiovascular disease: Time for a Change
Trence DL, Kelly JL, Hirsch, IB. J Clin Endocrninol Metab 2003: 88: 2430-2437
This protocol was adapted from the Markovitz protocol above, using four columns representing algorithms of increasing insulin resistance. Although the article reports success with this method, specific results are not reported.
Glucommander: a computer-directed intravenous insulin system shown to be safe, simple, and effective in 120,618 h of operation
Davidson PC, Steed RD, Bode BW. Diabetes Care. 2005; 28:2418-23.
The same concepts have been used to develop a computer assisted insulin infusion protocol. One such method has been published using the Glucommander but a number of institutions are using similar computer-assisted methods. This method has been at least as good as paper methods using a continuously updated insulin sensitivity algorithm. It should nearly eliminate nursing errors.
Other methods use the present glucose and change from last glucose to constantly adjust to any situations. They generally require more calculations by the nurse. These methods have been proposed to be more agile or flexible but there have been no direct comparisons with the column methods looking at effectiveness, nursing errors, or hypoglycemic risk.
Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project
Furnary AP, Wu Y, Bookin SO. Endocr Pract. 204; 10 (suppl 2):21-33.
Protocol used in cardiac surgery patients. It has been intensified at least four times since its original version in 1992. This particular version was used from 2001-2003 with a stated glucose goal of 100-150 mg/dl. It uses a combination of fixed adjustments (e.g. 0.5 units/hour) and relative adjustments (e.g. 50%). Goal glucose is reportedly attained in 3 hours. A more intensive protocol with a goal below 110 mg/dl is now used but this protocol has not been published. Although publications propose the updated protocols are found at www.portlandprotocol.org , the website does not have any protocol included at this time. The published material is quite detailed in terms of morbidity and mortality benefits but has much less detail about complications and nursing ease of use.
Intensive insulin therapy in critically ill patients
Van Den Berghe G, Wouters P, Weekers F, et al. N Engl J Med. 2001;345:1359-1367.
Protocol used in surgical ICU patients whenever glucose rose over 110 mg/dl. The same protocol was later used in a study of medical ICU patients with slightly different results (see more info about this protocol and paper in next section. Glucose goal is 80-110 mg/dl. Frequent adjustments using rate of change to calculate relative rate adjustments by the nurse. Reported ‹5% incidence of hypoglycemia but this was defined as glucose < 40mg/dl, suggesting a more significant issue, and the followup MICU paper had significantly high rates of hypoglycemia also. Best outcomes prospective outcomes study reported.
Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit
Goldberg PA, Siegel MD, Sherwin RS, et al. Diabetes Care. 2004; 27:461-467
Memoirs of a Root Canal Salesman: The Successful Implementation of a Hospital-Wide Intravenous Insulin Infusion Protocol
Goldberg PA. Endocrine Practice 2006; 12(suppl 3): 79-85.
Originally reported in Diabetes Care, with a goal of 100-139 mg/dl for medical ICU patients, this protocol has been republished with a goal range of 90-119 mg/dl. It utilizes two tables. The first helps the nurse identify the infusion rate “delta” according to the present BG and rate of glucose change. The second table converts the Δ to an insulin infusion rate change, dependent on the current infusion rate. Hypoglycemia (designated as < 60 mg/dl) is reported as 5.4% “of patient days” in the MICU and slightly lower in the cardiothoracic ICU. It uses 3 tables to adjust rates. Reached goal of 80-110 in 10.6 hours. Hypoglycemia is 1.6% < 60 mg/dl.
Design and Implimentation of GRIP, a computerized glucose control system at a surgical intensive care unit
Vogelzang M, Zijlstra F. and Nijsten, MWM. BMC: Medical Informatics and Decision Making. 2005; 5:38.
Use of a computer program receiving information directly from the POC testing and selects an ongoing infusion rate and interval for the next glucose test. It looks at rate of change over a period of hours in making calculations and recommendations. Glucose levels < 60 mg/dl occurred in about 11% of patients. The authors propose this will be free online in the future.
Performance of a dose-defining insulin infusion protocol among trauma service intensive care unit admissions
Braithwaite SS, Edkins R, MacGregor KL, et al. Diabetes Technol Ther. 2006;8:476–488.
Dr. Braithwaite is an author of the original Markovitz protocol, above, and has continued to evolve this protocol as have others. In this article, the authors publish their 6-column protocol, designed to attain glucose levels < 110 mg/dL in trauma patients. The hypoglycemic rate (< 70 mg/dL) was 11 hours.
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III. Insulin Infusion: Surgical / Medical Intensive Care Focus
Intensive insulin therapy in critically ill patients
Van Den Berghe G, Wouters P, Weekers F, et al. N Engl J Med. 2001;345:1359-1367.
This classic paper served as a catalyst for improving inpatient glycemic control. 1548 critically ill adult patients from surgical intensive care units were randomized to intensive insulin infusion to keep blood glucose levels < 110 mg/dL vs usual care. The intensive insulin infusion group enjoyed reduced mortality by 34%, and reduced important morbidities by 41-50%.
Intensive insulin therapy in the Medical ICU
Van den Berghe G, Wilmer A, Hermans G, et al. N Engl J Med. 2006;354:449-61
The long awaited followup study in MICU patients, using methodology very similar to the landmark “Van Den Berghe I” study of SICU patients, had mixed results. Several ICU morbidities, such as renal dysfunction and prolonged mechanical ventilation, were improved in the intensive infusion group, but overall mortality differences were not significantly different. Mortality was lower in the subpopulation in the MICU > 3 days, identified as an a priori population of interest. Concerns over excessive hypoglycemia and a non-significant increase in mortality in the subgroup in the MICU < 3 days have given some fuel for debate about what the ICU glycemic target should be and about the best methods to achieve it.
Effect of intensive glucose management protocol on the mortality of critically ill adult patients
Krinsley JS. Mayo Clin Proc. 2004;79:992-1000.
A protocol in a “real world” mixed MICU / SICU setting achieved glycemic control and related improvements in morbidity and mortality outcomes in a heterogenous population of critically ill inpatients. While not a RCT, this paper revealed that tight glycemic control was achievable, and was associated with improved outcomes similar to those found in the original Van Den Berghe study.
Insulin therapy for critically ill hospitalized patients: a meta-analysis of randomized, control trials
Pittas AG, Siegel RD, Lau J. Arch Inter Med. 2004;164:2005-2011. Meta-analysis of 35 clinical trials evaluating the effect of intensive insulin infusion therapy on mortality in critically ill inpatients found a 15% reduction in short-term mortality.
Survival benefits of intensive insulin therapy in critical illness: impact of maintaining normoglycemia versus glycemia-independent actions of insulin
Ellger B. Debaveye Y. Vanhorebeek I. Langouche L. Giulietti A. Van Etten E. Herijgers P. Mathieu C. Van den Berghe G. Diabetes. 2006; 55(4):1096-105
Multicentric, Randomized, Controlled Trial to Evaluate Blood Glucose Control by the Model Predictive Control Algorithm vs Routine Glucose Management Protocols in Intensive Care Unit Patients
Plank J et al. Diabetes Care: 2006 29 271-276
A practical approach to hyperglycemia management in the intensive care unit: evaluation of an intensive insulin infusion protocol
Quinn JA, Snyder SL, Berghoff JL et al. Pharmacotherapy. 2006; 26:1410-20.
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IV. Insulin Infusion and Effects of Hyperglycemia on Cardiac Surgery and Myocardial Infarction
Value of postoperative blood glucose in predicting complications and length of say after coronary artery bypass grafting
Fish LH, Weaver TW, Moore AL, Steel LG. Am J Card 2003;92:74-76.
Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery.
Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, et al. Ann Intern Med. 2007:146:233-243
This single center study that already had an intensive insulin infusion protocol in place in their SICU randomized 400 patients undergoing on-pump cardiac surgery to tight (target 80-100 mg/dL, mean glucose 114 mg/dL) vs usual (infusion started if glucose > 200 mg/dL, mean 157 mg/dL) glycemic control introperatively. All patients received tight glycemic control in the cardiac ICU. The composite outcomes showed no difference between the two groups. More patients suffered from stroke in the intervention arm (8 patients vs 1 patient, p = .02). Death occurred in 4 intervention patients and no control patients, p = .06. All other outcomes showed no difference. The thoughtful accompanying editorial by van den Berghe offers perspective.
Does Tight Blood Glucose Control during Cardiac Surgery Improve Patient Outcome?
Van den Berghe G. Ann Intern Med 2007;146;307-308.
Cardiac Surgery - Portland Experience
Clinical Effects of Hyperglycemia in the Cardiac Surgery Population: The Portland Diabetic Project
Furnary AP, Wu Y. Endocr Pract. 2006:12 (Suppl 3): 22-26.
The paper is the latest update of the Portland Diabetic Project, a prospective, non-randomized, observational study of 5,510 consecutive diabetic cardiac surgery patients spanning 1987-2005. The three day blood glucose average (3-BG) has been progressively reduced for the population through the use of continuous insulin infusion (CII). Both CII for three days duration and a favorable 3-BG were independently associated with improved mortality, deep sternal wound infection rates, and length of stay. Diabetes itself is not an independent risk factor for adverse outcomes, while hyperglycemia is. More Portland experience is recounted in the four reports that follow.
Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project
Furnary AP, Wu Y, Bookin SO. Endocr Pract. 2004; Suppl 2:21-33.
Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting
Furnary AP, Gao G, Grunkemeier GL, et al. J Thorac Cardiovasc Surg. 2003;125:1007-21.
Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures
Furnary AP, Zerr KJ, Grunkemeier GL, et al. Ann Thorac Surg. 1999;67:352-60; discussion 360-2.
Glucose control lowers the risk of wound infection in diabetics after open heart operations
Zerr KJ, Furnary AP, Grunkemeier GL, et al. Ann Thorac Surg. 1997;63:356-361.
Cardiac Surgery - Other Experience
Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting
Estrada CA, Young JA, Nifong LW, et al. Ann Thorac Surg 2003;75:1392-9.
For patients undergoing CABG, each 50 mg/dL increase in BG level added 0.76 days to LOS and increased inpatient costs by $2,824.
Each 50 mg/dL lowering of the 3 day average post op blood glucose reduced LOS by 1 day.
The association of diabetes and glucose control with surgical site infection among cardiothoracic surgery patients
Latham R, Lancaster AD, Covington JF, et al. Infec Control Hosp Epidemiol. 2001;22:605-212.
Myocardial Infraction
Hyperglycemia, diabetes and glucose intolerance are common conditions in patients with acute MI with hyperglycemia is strongly and consistently associated with poor outcomes in these patients.
Inpatient Diabetes: Review of Data from the Cardiac Care Unit
Hirsch, I. Endocrine Practice 2006: 12 Supp 3 27-34
A nice recent review of prospective and retrospective studies exploring the relationship between inpatient hyperglycemia / diabetes and the acute MI patient.
Myocardial Infraction - DIGAMI 1
Prospective randomized study of intensive insulin treatment on long-term survival after acute myocardial infarction in patients with diabetes mellitus
Malmberg K. BMJ. 1997;314:1512-1515.
Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study
Malmberg K, Norhammar A, Wedel H, et al. Circulation. 1999;99:2626-32.
DIGAMI I treatment arm patients were randomized to glucose insulin infusion for 24 hours followed by multiple daily injections of insulin for 3 or more months. They experienced a 29% reduction in mortality at one year that held up on follow-up at an average of 3.4 years.
Myocardial Infraction - DIGAMI 2 and CREATE-ECLA
In both DIGAMI 2 and CREATE-ECLA, insulin-glucose infusion patients failed to reach glycemic targets, and showed that insulin infusion, in the absence of improved glycemic control, has no effect on outcomes.
Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity
Malmberg K, Ryden L, Wedel H; DIGAMI 2 Investigators. Eur Heart J. 2005;26:650-61.
Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: the CREATE-ECLA randomized controlled trial
Mehta SR, Yusuf S, Diaz R; CREATE-ECLA Trial Group Investigators. JAMA. 2005;293:437-46.
Other Studies in Acute Myocardial Infarction
Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes : a systematic overview
Capes SE, Hunt D, Malmberg K, Gerstein HC. Lancet. 2000;355:773-778. This meta-anlaysis of 15 studies of hospitalized acute MI patients reported that blood glucose levels > 110 mg/dL were associated with more mortality and CHF.
Short-term mortality of myocardial infarction patients with diabetes or hyperglycaemia during admission
Sala J, Masia R, Gonzalez de Molina FJ; REGICOR Investigators. J Epidemiol Community Health. 2002;56:707-12.
Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes
Kasiborod M, Rathore SS, Inzucchi S et al. Circulation 2005;111:3078.
Acute hyperglycemia is associated with adverse outcomes after acute myocardial infarction in the coronary intervention era
Ishihara M, Kojima S, Sakamoto T, et al. Am Heart J. 2005;150:814-20.
Acute hyperglycemia, but not the pre-existing label of diabetes, was a predictor of inpatient mortality after acute MI, in this study of 1,253 patients.
Prognostic value of admission glucose in non-diabetic patients with myocardial infarction
Timmer JR, van der Horst IC, Ottervanger JP, et al. Am Heart J. 2004; 148:399-404.
Elevated glucose levels were associated with larger infarct size and reduced residual LV function in 356 patients without a diagnosis of diabetes, who were being treated with reperfusion therapy for ST-segment elevation MI.
The association between hyperglycaemia on admission and 180-day mortality in acute myocardial infarction patients with and without diabetes
Ainla T, Baburin A, Teesalu R, et al. Diabet Med. 2005;22:1321-5.
Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study
Norhammar A, Tenerz A, Nilsson G, et al. Lancet. 2002;359:2140-4.
Undiagnosed diabetes and impaired glucose tolerance were found to be common in acute MI patients without a prior diagnosis of diabetes.
Impaired glucose metabolism predicts mortality after a myocardial infarction
Bolk J, van der Ploeg T, Cornel JH et al. Int J Cardiol. 2001; 79:207-14.
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V. Hyperglycemia in Medical / Surgical Wards and Other Conditions
Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes
Umpierrez GE, Isaacs SD, Bazargan N, et al. J Clin Endocrinol Metab. 2002;87:978-982.
Retrospective review of 1,886 hospitalized patients revealed that in hospital hyperglycemia was very common and patients with hyperglycemia frequently did not have a pre-existing diagnosis of diabetes. Hyperglycemia in those without prior diagnosis of diabetes carried an 18-fold increased risk of mortality, while those with hyperglycemia and a prior history of diabetes had a 2.5 fold increase in mortality compared to a control group.
Newly Diagnosed Diabetes/ Hyperglycemia in Hospitals: What should we do?
Fonseca, V. Endocrine Practice 2006; 12; supp 3: 108-111
Hyperglycemia associated with poor outcomes in a broad variety of conditions and populations
Admission hyperglycemia as a prognostic indicator in trauma
Yendamuri S, Fulda GJ, Tinkoff GH. J Trauma. 2003;55:33-8.
Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview
Capes SE, Hunt D , Malmberg K Pathak P, et al. Stroke 2001;32:2426-2432.
IV insulin during acute cerebral infarction in diabetic patients
Bruno A, Saha C, Williams et al. Neurology. 2004; 62:1441-2.
How important is hyperglycemia during acute brain infarction?
Bruno A, Williams LS, Kent TA. Neurologist. 2004; 10:195-200. Review.
Perioprerative glycemic conrol and risk of infectious complications in a cohort of adult with diabetes
Golden S, Peart -Vigilance C Kao W, et al. Diabetes Care 1999;22:1408-1414.
Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of european prospective investigation of cancer and nutrition (EPIC-Norfolk).
Khaw KT, Wareham N, Luben R, et al. BMJ. 2001;322:1-6
Unrecognized diabetes among hospitalized patients.
Levetan CS, Passaro M, Jablonski K, Ratner RE. Diabetes Care.1998;21:246-249.
Early postoperative glucose control predicts nosocomial infection rate in diabetic patients
Pomposelli JJ, Baxter JK, Babineau TJ, et al. J Parenter Enteral Nutr. 1998;22:77-81.
Relation between the duration of remission and hyperglycemia during induction chemotherapy for acute lymphocytic leukemia with a hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone/methotrexate-cytarabine regimen
Weiser MA, Cabanillas ME, Konopleva M,et al. Cancer. 2004; 100 (6):1179-85.
Early peri-operative glycaemic control and allograft rejection in patients with diabetes mellitus: a pilot study
Thomas MC, Mathew TH, Russ GR et al. Transplantation. 2001; 72 (7):1321-4.
The relation between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia
McAlister FA. Majumdar SR. Blitz S. Rowe BH. Romney J. Marrie TJ. Diabetes Care 2005: 28: 810-815.
Resources with tips on subcutaneous insulin regimens and implementation strategies (and often infusion regimens as well)
Glycemic Control Workbook
The Society of Hospital Medicine's Glycemic Control Workbook found in the Improve section of this resource room is a great resource.
View the Glycemic Control Workbook.
American Diabetes Association Diabetes in Hospitals Writing Committee
Clement S, Braithwaite SS, Magee MF et al. Diabetes Care. 2004;27:553-91.
Subcutaneous insulin therapy in the hospital setting: issues, concerns, and implementation
Magee MF, Clement S. Endocr Pract. 2004;10 Suppl 2:81-8.
Hospital management of diabetes: Beyond the sliding scale
Moghissi E. Cleveland Clin J Med.2004;71:801-808.
Hospital Management of Diabetes
Moghissi ES, Hirsch IB. Endocrinol Metab Clin N Am 34 (2005) 99-116.
Hyperglycemia in the hospital. Diabetes Spectrum
Thompson CL, Dunn KC, Menon MC, Kearns LE, Braithwaite SS. 2005;18:20-27.
Management of Hyperglycemia in the Hospital Setting
Inzucchi S. N Engl J Med 2006;355:1903-11.
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VI. Iatrogenic Hypoglycemia and Sliding Scale Insulin
Glycemic Control and Sliding Scale Insulin Use in Medical Inpatients with Diabetes Mellitus
Queale et al. Arch Intern Med. 1997;157:545-552.
In a study by Queale and colleagues, 171 patients admitted to one of 6 medical services were 3 times more likely to experience hyperglycemia with either a conservative or aggressive sliding scale regimen over a 4 day period post-admission. Moreover, blood glucose levels in these patients were highly variable as 23% of patients experienced hypoglycemic episodes and 40% experienced glycemic excursions > 300 mg/dL. Furthermore, there was no significant change in glycemic control over the 4 day period.
Causes of hyperglycemia and hypoglycemia in adult inpatients
Smith WD, Winterstein AG, Johns T, et al. Am J Health-Syst Pharm 2005;62:714-719.
Hospital hypoglycemia: not only treatment but also prevention
Braithwaite SS. Buie MM. Thompson CL. Baldwin DF. Oertel MD. Robertson BA. Mehrotra HP. Endocrine Practice 2004: 10 Suppl 2:89-99
Hypoglycemia: An Excuse for Poor Glycemic Control?
Saleh M, Grunberger G. Clin Diabetes. 2001;19(4): 161-167.
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VII. Financial Aspects of Inpatient Glycemic Control
Analysis of healthcare resource utilization with intensive insulin therapy in critically ill patients
Van den Berghe G. Wouters PJ. Kesteloot K. Hilleman DE. Critical Care Medicine.2006 34(3):612-616
Cost Analysis of Glycemic Control in Critically Ill Adult Patients
Krinsley JS, Jones RL. Chest 2006:129:644-650.
American Hospital Directory
Medicare Prospective Payment System. Accessed 12-1-06 at http://www.ahd.com/pps.html.
ICD-9-CM Professional. 6th Edition
Management of diabetes and hyperglycemia in hospitals
Clement S, Braithwaite SS, Magee MF, et al on behalf of the American Diabetes Association Diabetes in Hospitals Writing Group. Diabetes Care 2004; 27:553-91.
Financial Implications of Glycemic Control: Results of an Inpatient Diabetes Management Program
Newton CA, Young S. Endocrine Practice. 2006;12(S3): 43-48.
Impact of Endocrine and Diabetes Team Consultation on Hospital Length of Stay for Patients with Diabetes
Levetan CS, Salas JR, Wilets IF, Zumoff B. AJM. 1995; 99: 22-28.
Effect of Hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland diabetes project
Furnary AP, Wu Y, Bookin S. Endocr Pract. 2004;10:21-33.
Reduction of Surgical Mortality and Morbidity in Diabetic Patients Undergoing Cardiac Surgery with with a Combined Intravenous and Subcutaneous Insulin Glucose Management Strategy
Schmeltz LR, DeSantis AJ, Thiyagarajan V, Schmidt K, O'Shea E, Johnson D, Henske J, McCarthy PM, Gleason TG, McGee EC, Molitch ME. Diabetes. 2006; Abstract for ADA Annual Meeting.
Inpatient Management of Hyperglycemia: the Northwestern Experience
DeSantis AJ, Schmeltz LR, Schmidt K, O'Shea-Mahler E, Rhee C, Wells A, Brandt S, Peterson S, Molitch M. Endocrine Practice. 2006;12: 491-505. Recently published.
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