Introduction

Diabetes is a prevalent metabolic disorder affecting more than 460 million people globally, with projections indicating a rise to 700 million by 2045. In the United States alone, 34.2 million Americans or 10.5% of the population have diabetes. This prevalence is expected to soar, with projections suggesting that as many as one in three U.S. adults will have diabetes by 2050. People with diabetes have a 35% greater chance of referral for elective operations and up to a 4-fold greater chance of hospitalization compared to those without diabetes. Furthermore, patients with diabetes tend to have longer hospital stays than those without the condition.

This course reviews the pathophysiology of hyperglycemia during illness, mechanisms for increased complications and mortality due to hyperglycemia and hypoglycemia, and explores the evidence supporting different therapies for the management of inpatient diabetes and hyperglycemia in both critical care and general medicine and surgical settings.

Prevalence of Diabetes and Hyperglycemia in Hospitalized Patients

Observational studies have reported a prevalence of hyperglycemia and diabetes ranging from 38% to 40% in hospitalized patients. Stress hyperglycemia or hospital-related hyperglycemia is defined as any blood glucose concentration >140 mg/dl in patients without a prior history of diabetes. Measurement of HbA1c is indicated in people with hyperglycemia without a history of diabetes to differentiate between stress-induced hyperglycemia and previously undiagnosed diabetes.