Medical Nutrition Therapy in Hospitalized Patients with Diabetes
Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.Current Diabetes Reports (Impact Factor: 3.08). 02/2012; 12(1):93-100. DOI: 10.1007/s11892-011-0236-5
Medical nutrition therapy (MNT) plays an important role in management of hyperglycemia in hospitalized patients with diabetes mellitus. The goals of inpatient MNT are to optimize glycemic control, to provide adequate calories to meet metabolic demands, and to create a discharge plan for follow-up care. All patients with and without diabetes should undergo nutrition assessment on admission with subsequent implementation of physiologically sound caloric support. The use of a consistent carbohydrate diabetes meal-planning system has been shown to be effective in facilitating glycemic control in hospitalized patients with diabetes. This system is based on the total amount of carbohydrate offered rather than on specific calorie content at each meal, which facilitates matching the prandial insulin dose to the amount of carbohydrate consumed. In this article, we discuss general guidelines for the implementation of appropriate MNT in hospitalized patients with diabetes.
- [Show abstract] [Hide abstract]
ABSTRACT: The aim was to formulate practice guidelines on the management of hyperglycemia in hospitalized patients in the non-critical care setting. The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee of The Endocrine Society, six additional experts, and a methodologist. This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society members, American Diabetes Association, American Heart Association, American Association of Diabetes Educators, European Society of Endocrinology, and the Society of Hospital Medicine reviewed and commented on preliminary drafts of this guideline. Hyperglycemia is a common, serious, and costly health care problem in hospitalized patients. Observational and randomized controlled studies indicate that improvement in glycemic control results in lower rates of hospital complications in general medicine and surgery patients. Implementing a standardized sc insulin order set promoting the use of scheduled basal and nutritional insulin therapy is a key intervention in the inpatient management of diabetes. We provide recommendations for practical, achievable, and safe glycemic targets and describe protocols, procedures, and system improvements required to facilitate the achievement of glycemic goals in patients with hyperglycemia and diabetes admitted in non-critical care settings.
- [Show abstract] [Hide abstract]
ABSTRACT: An analysis of patient safety incidents has noted that the prescribing and administration of subcutaneous injection (SC) insulin has been performed in an unsafe manner on frequent occasions, resulting in poor diabetes control, increasing hospital admissions and potentially putting lives at risk. The National Diabetes Inpatient Audit of acute hospitals found outcomes for people with diabetes were poorer due to common medication errors, and their hospital stay was on average three nights longer (NHS Diabetes, 2010). This article presents an in-depth examination and critical analysis of the process of safe administration of SC insulin within an acute setting. A pilot study was undertaken to investigate the knowledge of insulin and administration safety in one hospital surgical ward.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.