TY - JOUR
T1 - High incidence of hypoglycemia from an audit of glycemic control and management in patients with diabetes in a cardiac unit
AU - Ong, May Lea
AU - Teede, Helena Jane
AU - Zoungas, Sophia
AU - Wong, Jennifer Lee Ann
PY - 2013
Y1 - 2013
N2 - The coronary care unit (CCU) model of
care has evolved considerably over the past
several decades and emerged as one of
the most important advances in the care
of patients with acute coronary syndrome
(ACS). The concept of a specific unit for
patients with ACS equipped with highly
trained and specialized staff was initially
introduced in the 1960s, but it was not until
1980s that the idea took off with the advent
of coronary angiography and fibrinolytic
therapy (1). However, in this new modern
environment with high rate of cardiac
interventions and patient turnover, many
challenges have been created with competing
demands for nursing time. These challenges
are even greater in patients with diabetes
frequently who require rapid intensification
of therapy to optimize blood
glucose levels whilst needing procedures
which require fasting.
The prevalence of diabetes in hospitalized
patients is significant and is on an
increasing trend. However, this figure is
not well documented and hence significantly
underestimated (2, 3). More than a
decade ago, 12.4 of hospital discharges
in the United States have diabetes documented
as a diagnosis (4). More recently,
the prevalence of diabetes was recorded
from at least 10 and up to 25 of adult
patients admitted to hospitals in theUnited
Kingdom (5). Not surprisingly, this figure
is increased in high-risk groups, particularly,
patients admitted to a CCU. A 11-
years review of patients admitted to a CCU
in Italy found a prevalence of diabetes at
31.5 and almost 40 with concomitant
ST-elevation myocardial infarction (6). The combination of the busy modern
CCU environment and the high and
increasing number of patients with diabetes
creates a high-risk setting for hypoglycemia.
Severe hypoglycemia is known to
be associated with increased morbidity and
mortality in hospitalized patients and has
been postulated to be associated to a range
of adverse clinical outcomes or at least a
marker of vulnerability to such events (7).
This finding has been extended to patients
hospitalized with ACS, where severe hypoglycemia
was a major predictor of cardiovascular
death (8). Similarly, hypoglycemia
has also been implicated in the excess allcause
mortality observed in this patient
group (9).
AB - The coronary care unit (CCU) model of
care has evolved considerably over the past
several decades and emerged as one of
the most important advances in the care
of patients with acute coronary syndrome
(ACS). The concept of a specific unit for
patients with ACS equipped with highly
trained and specialized staff was initially
introduced in the 1960s, but it was not until
1980s that the idea took off with the advent
of coronary angiography and fibrinolytic
therapy (1). However, in this new modern
environment with high rate of cardiac
interventions and patient turnover, many
challenges have been created with competing
demands for nursing time. These challenges
are even greater in patients with diabetes
frequently who require rapid intensification
of therapy to optimize blood
glucose levels whilst needing procedures
which require fasting.
The prevalence of diabetes in hospitalized
patients is significant and is on an
increasing trend. However, this figure is
not well documented and hence significantly
underestimated (2, 3). More than a
decade ago, 12.4 of hospital discharges
in the United States have diabetes documented
as a diagnosis (4). More recently,
the prevalence of diabetes was recorded
from at least 10 and up to 25 of adult
patients admitted to hospitals in theUnited
Kingdom (5). Not surprisingly, this figure
is increased in high-risk groups, particularly,
patients admitted to a CCU. A 11-
years review of patients admitted to a CCU
in Italy found a prevalence of diabetes at
31.5 and almost 40 with concomitant
ST-elevation myocardial infarction (6). The combination of the busy modern
CCU environment and the high and
increasing number of patients with diabetes
creates a high-risk setting for hypoglycemia.
Severe hypoglycemia is known to
be associated with increased morbidity and
mortality in hospitalized patients and has
been postulated to be associated to a range
of adverse clinical outcomes or at least a
marker of vulnerability to such events (7).
This finding has been extended to patients
hospitalized with ACS, where severe hypoglycemia
was a major predictor of cardiovascular
death (8). Similarly, hypoglycemia
has also been implicated in the excess allcause
mortality observed in this patient
group (9).
UR - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819619/
U2 - 10.3389/fendo.2013.00168
DO - 10.3389/fendo.2013.00168
M3 - Article
VL - 4
SP - 1
EP - 2
JO - Frontiers in Endocrinology
JF - Frontiers in Endocrinology
SN - 1664-2392
IS - Art. No.: 168
ER -