Inpatient Glycemic Management: What Are the Goals and How Do We Achieve Them?: Preface

Jane Jeffrie Seley, DNP, MSN, MPH, BC-ADM, CDE, CDTC, Guest Editor The publication of this Diabetes Spectrum From Research to Practice section on inpatient glycemic management coincides with my 10th anniversary as an inpatient diabetes nurse practitioner at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City. This decade has been a remarkable journey, marked by a slow but steady national shift from slidingscale to basal-bolus insulin therapy in hospitals, with an accompanying culture change from one in which the majority doubted the dangers of inpatient hyperglycemia to a new reality in which more health care professionals (HCPs) realize that, for inpatients, “glycemic control really matters.” Hyperglycemia is common in hospitalized patients with and without diabetes.1 Since 2004, various organizations have published inpatient guidelines,1–4 but these have been based on limited evidence and a great deal of expert opinion and have not always been widely adopted. Because of the lack of evidence and continuing debate over best practices, the PRIDE (Planning Research in Inpatient Diabetes) research group formed and published a call to action5 to promote clinical trials testing high-quality, costeffective, and sustainable inpatient hyperglycemia management strategies. There are many components to inpatient glycemic management, all of which require ongoing assessment and care coordination to achieve targets in the setting of acute illness. The first task is to recognize hyperglycemia and diabetes in hospitalized patients. High-risk individuals must be identified soon after admission and appropriately monitored to ensure adequate treatment.1 Glycemic targets should be well known to all clinical staff, and these patients’ daily glucose results should be reviewed during rounds and in shift reports so timely action can be taken to initiate and intensify therapy as needed. Inpatient treatment of hyperglycemia mirrors the key strategies we rely on for outpatients: meal planning, pharmacological therapy, hypoglycemia prevention, and self-management education. The additional challenge in acute care is that patients often are quite ill from other conditions and may have limited ability to participate in self-care. Here, we provide an update on strategies to manage diabetes and hyperglycemia during hospitalization and to send patients home with a safe and effective discharge plan. Whether at home or in the hospital, nutrition plays a key role in achieving glycemic targets. Over the past decade, hospital meals have been moving from a focus on calories to a more diabetes-friendly consistentcarbohydrate meal plan, as suggested by the Endocrine Society.1 Thus, our discussion begins with an article by Donna B. Ryan, MPH, RN, CDE, and Carrie S. Swift, MS, RD, BC-ADM, CDE (p. 163), about one of our greatest challenges: how to better coordinate the timing of blood glucose monitoring, insulin administration, and meal delivery in the fast-paced inpatient arena. These authors include a list of quality improvement strategies that may resolve some of the barriers to improving coordination of these key tasks. They also identify potential roadblocks to adequate nutrition during hospitalizations and offer evidence-based solutions. Ryan and Swift stress the importance of interdisciplinary collaboration among prescribers, nurses, dietitians, and food service staff to promote the provision of opti-