[Diabetes Care 22(1):s80, 1999. © 1999 American Diabetes Association, Inc.]
These guidelines are to be used for determining when a patient requires hospitalization for reasons related to diabetes. Inpatient care may be appropriate in the following situations:
Modification of fixed insulin-treatment regimens or sulfonylurea treatment is not, by itself, an indication for hospital admission.
Guidelines for hospital admission are given below. Guidelines are never a substitute for medical judgment, and each patient's total clinical and psychosocial circumstances must be considered in their application. Therefore, there may be situations in which admission is appropriate, although the patient's clinical profile does not comply with these guidelines. For example, inadequate family resources may dictate admission of newly diagnosed type 1 diabetic patients who otherwise do not meet the admission guidelines.
Admission is appropriate for the following:
Blood glucose >250 mg/dl (>13.9 mmol/l) with 1) arterial pH <7.35, venous pH <7.30, or serum bicarbonate level <15 mEq/l and 2) ketonuria and/or ketonemia.
Hyperosmolar nonketotic state
Impaired mental status and elevated plasma osmolality in a patient with hyperglycemia. This usually includes severe hyperglycemia (e.g., 400 mg/dl [22.2 mmol/l]) and elevated plasma osmolality (e.g., 315 mOsm/kg [315 mmol/kg]).
Hypoglycemia with neuroglycopenia
Poor metabolic control of established diabetes as defined herein justifies admission if it is necessary to determine the reason for the control problems and to initiate corrective action. For admission under these guidelines, documentation should include at least one of the following:
Chronic cardiovascular, neurological, renal, and other diabetic complications may progress to the stage where hospital admission is appropriate. In these situations, the needs governing admission for the complication per se (e.g., management of end-stage renal disease) are the primary guidelines for determining whether inpatient care is required. However, in applying such guidelines, the fact that diabetes is present must be considered; this may result in patients requiring admission who otherwise might be managed on an outpatient basis. The same is true for other medical conditions (e.g., infections) and treatments (e.g., surgery, chemotherapy) in which 1) diabetes is a confounding factor, 2) rapid initiation of rigorous control of diabetes can improve outcome (e.g., pregnancy), 3) the primary medical problem or the therapeutic intervention (e.g., large doses of glucocorticoid) can cause a major deterioration in diabetes control, or 4) there is acute onset of retinal, renal, neurological, or cardiovascular complications of diabetes.
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