Braithwaite defines specific populations, disorders, and hospital settings for which there now is strong evidence supporting the belief that short-term glycemic control will affect outcomes during the course of hospital treatment. 1 She provides a comprehensive summary of key studies showing the benefits of tight glycemic control in hospitalized patients. Dr. James S. Krinsley reviews the evidence that supports more intensive glucose control, along with a "real-world" success story that demonstrates how to apply the new glycemic targets in a multidisciplinary performance improvement project. 2 He discusses important issues surrounding the successful implementation of a tight glycemic control protocol, including barriers to implementation, setting the glycemic target, and tips for choosing the right protocol. Dr. Franklin Michota describes a practical guideline for how to implement a more physiologic and sensible insulin regimen for management of inpatient hyperglycemia. 3 He reports on the disadvantages of the sliding scale and recommends the implementation of a standardized subcutaneous insulin order set with the use of scheduled basal and nutritional insulin in the inpatient management of diabetes. Drs. Asudani and Calles-Escandon focus on the management of non-critically ill patients with hyperglycemia in medical and surgical units. 4 They propose a successful insulin regimen to be used in non-ICU settings that is based on the combined use of basal, alimentary (prandial), and corrective insulin. This supplement provides the hospitalist physician with the necessary tools to implement glycemic control programs in critical care and noncritical care units and can be summarized as follows.
Hyperglycemia in hospitalized patients is a common, serious, and costly health care problem with profound medical consequences. Thirty-eight percent of patients admitted to the hospital have hyperglycemia, about one third of whom have no history of diabetes before admission. 5 Increasing evidence indicates that the development of hyperglycemia during acute medical or surgical illness is not a physiologic or benign condition but is a marker of poor clinical outcome and mortality. [5][6][7][8][9][10] Evidence from observational studies indicates that the development of hyperglycemia in critical illness is associated with an increased risk of complications and mortality, a longer hospital stay, a higher rate of admission to the ICU, and a higher likelihood that transitional or nursing home