Tight Control in the Hospital Questioned :: Diabetes Self-Management

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Aug 29, 2008

Tight Control in the Hospital Questioned

Tara Dairman

A new analysis of multiple studies has found that tight blood glucose control (keeping blood glucose levels as close to normal as possible) does not reduce the risk of dying in the hospital in people who are critically ill.

In a meta-analysis (analysis of data from several clinical trials) published in The Journal of the American Medical Association on August 27, researchers looked at 29 studies with a total of 8,432 participants. Their analysis found a 21.6% rate of death among people who had been on tight blood glucose control during their hospital stays and a 23.3% death rate among those receiving usual care—not a significant difference.

Further analyses of data from some of the trials found no significant difference between the groups in risk for needing to start dialysis. People on tight control did, however, experience a significantly decreased risk of septicemia (illness due to bacteria in the blood)—10.9% in people with tight control vs. 13.4% of people receiving usual care. But people on tight control also had five times the risk of hypoglycemia—13.7% vs. 2.5%.

Commenting on their findings, the researchers suggested that "the guidelines recommending tight glucose control in all critically ill patients should be reevaluated until the results of larger, more definitive clinical trials are available." But in a separate editorial, researchers not involved in this study commented that studies included in this meta-analysis or the meta-analysis itself may have been flawed. They also said that research is needed to see if tight control reduces death rates in the hospital under optimal conditions before a conclusion can be made.

Have you had experience with tight control of your blood glucose levels in the hospital? Do you think this affected your recovery? Share your thoughts with a comment below.

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Oh come on! You're the own who wrote about taking cinnamon in capsules. Hello? Whatever happened to sprinkling it on toast?

May I suggest you write one article without using "%". Stick to common sense- it works...

Posted by: help4mac | Aug 31, 2008 03:12 AM

I've read many articles on diabetes on different web sites. Many of them mention frequent urination but none of them has defined 'frequent'.
Does anyone know what is considered 'frequent'? Is it evry 5 minutes or every half hour or what? Somehow I always forget to ask my doctor about this when I see him because the other issues always seem more important and urination is forgotten.

Posted by: John | Sep 01, 2008 02:14 PM

The hospitals that I have been in in the past several years do not seem to know about counting carbs. They seem to like to give you sweetened desserts, BOWLS of pasta and/or large quantities of mashed potatoes. These, regardless of "tight controls" will surely spike not only a diabetics blood sugar count but even a non diabetic.

Posted by: Ottilie | Sep 03, 2008 12:37 PM

I would rather have a slightly high reading than have an insulin reaction in the hospital.

Posted by: Jay | Sep 03, 2008 01:05 PM

I am diabetic from last 16 years. I need to go on insulin. so what is the tight control?

Posted by: Rasheed | Sep 03, 2008 02:05 PM

Dear Tara. You wonder if the hospital is a good place for tight control since I find when I am sick it is very difficult to control the blood sugar at all. Considering that the people in the hospital are also under great stress. Most hospitals are also short on staff. The food is also usually heavy on carbs making the task very difficult.

It is interesting to read that tight control lowers the incidence of septicimia a little.

Posted by: CalgaryDiabetic | Sep 03, 2008 02:27 PM

When I have been in the hospital they usually watch my sugar levels and go from there!

Posted by: Kristy | Sep 03, 2008 02:50 PM

Rasheed,

For a definition of tight control, click here. You may also be interested in our article "The Benefits of Tight Control: No End in Sight."

Posted by: Tara Dairman, Web Editor | Sep 03, 2008 02:52 PM

Tight bg control in hospital - now that is a joke!
Having been in the hospital several times in 2007 I could never acheive it of course when the anesthesiologist insists on dropping the basil to .5 and then hanging 5% destrose durning and after surgery with no change in basal rate or discontinuation of the 5% destrose tight control is impossible subsequent to surgery. Mine registered 550 when I finally reached my room post op. Spoke with my diabetes doc later and she told me that she has spoken with anesthesiologists even argued with them to no avail. One in particular is impossible to reason with and I have been unfortunate enough to have him for 2 surgeries. Never again!I was fortunate enough to have a surgeon who was right on the problem and was able to resolve the high blood sugars.

Posted by: jlholbert | Sep 03, 2008 03:19 PM

I have been in the hospital several times for various problems ie congestive heart failure, and infected bronchial tubes. I am a Type II diabetic and the doctors want to tell me how much insulin I should be taking and the nurses have to adhere to the orders. Well, here is where the war begins. The nurses tell me what the dosage is to be according to my glucose reading was. I tell them the dosage is wrong and the war starts. I am the diabetic and I am in control of my dosage, not the doctor, because I have my own insulin medications. Eventually I win and the the insulin dose is given to the nurse. I take Apidra and Lantus. So for all you diabetics who end up in the hospital and are incontrol of your senses, take command of your own insulin dosage.

Posted by: tldell | Sep 03, 2008 05:35 PM

The last time I was in the hospital the dietician refused to give me the same diet I had been used to at home. I was constantly having lows - I would wake up at night with insulin reactions - on one particular night, no one heeded my busser, I waited until I started breaking out in a sweat, then I knew I had to help my self! I got out of bed and when my feet hit the floor I knew I could not walk to the refrigator, so I crawled out to the hall where the food was stored - still no nurse in sight - I helped myself to juice and cookies! I stayed there until I went to sleep!

I woke up in my bed - I told my doctor about the episode and asked to be discharged that day. I would rather be at home than go through that awful experience again! I was admitted to the hospital so my insulin could be adjusted - I had been on oral medication since being diagnosed, and it was no longer keeping me in good control. This was my introduction to insulin and hospital care! No thanks!!!

Posted by: bmartin | Sep 03, 2008 06:22 PM

I have been a practicing Type 1 for 41 years and fortunately I have never been hospitalized. I have spent some time in the ER recovering from hypoglycemia back in the days when I was trying to do MDI with R and NPH. That changed with the Rapid and 24 hour insulins and now the pump.
I would recommend that anyone who takes insulin to control blood sugar have a prepared statement of Guidelines for the Hospitalized MDI/Pump Patient. I think it would be a good topic for an article in DSM.

Posted by: Florian | Sep 04, 2008 08:55 AM

I am a type 2 diabetic who was hospitalized for tests and they gave me an insulin shot because mine was too high. I was in a lot of pain and as we all know when you're in a lot of pain, your glucose is all over the place. It did nothing for me except for me to get in the normal range for about an hour or two, then it went right back up and I was being discharged that day. They were going to give me another shot with breakfast and I told them not to bother and of course the nurse had to go check it out with the doctor but they finally released me.

Posted by: Faye | Sep 05, 2008 02:46 PM

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