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Hyperglycemia Management In Hospitalize Patients

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Diabetes and hyperglycemia management in hospitalize patients Introduction Worldwide, Diabetes mellitus is one of the most significant causes of morbidity and mortality, and its global impact is likely to accelerate over the next coming decades. International Diabetes Federation (IDF) 2015 reports, 415 million people have diabetes. By 2040 this will rise to 642 million. In every country, the number of people with type 2 diabetes is increasing. According to the IDF, 1 in 10 adults will have diabetes by 2040. The global cost of diabetes—based on statistics from the World Health Organization and the International Diabetes Federation Diabetes Atlas—was $1.31 trillion for 2015 [2]. Diabetic patients have a 3 fold greater chance of hospitalization…show more content…
The American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE) consensus on inpatient hyperglycemia defined stress hyperglycemia or hospital-related hyperglycemia as any blood glucose concentration >140 mg/dl (>7.8 mmol/l) [12,13]. Measurement of an HbA1c is indicated in patients with hyperglycemia without a history of diabetes to differentiate between stress hyperglycemia and previously undiagnosed diabetes [32-34]. The Endocrine Society recommendations indicate that hospitalized patients with elevated blood glucose and an HbA1C of 6.5% (48 mmol/mol) or higher can be identified as having diabetes [12]. PATHOPHYSIOLOGY OF HYPERGLYCEMIA DURING…show more content…
Several mechanisms explain the detrimental effects of hyperglycemia (Fig. 1). Hyperglycemia causes osmotic diuresis that leads to hypovolemia, decreased glomerular filtration rate, and prerenal azotemia. Hyperglycemia is associated with impaired leukocyte function, including decreased phagocytosis, impaired bacterial killing, and chemotaxis, leading to hospital infections and poor wound healing. In addition, acute hyperglycemia results in the activation of nuclear factor κB (NF-κB), the production of proinflammatory cytokines, and oxidative stress, leading to increased vascular permeability and mitochondrial dysfunction (29,30). Furthermore, hyperglycemia impairs endothelial function by suppressing formation of nitric oxide and impairing endothelium-dependent, flow-mediated dilation
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