Dietary Intervention for Inpatient Glycemic Control

While recommendations for inpatient glycemic control suggest a conservative target of 140-180mg/dL, many struggle to achieve this goal. Glycemic control begins with a carbohydrate-controlled diet, but many inpatient diets continue to be suboptimal and can contribute to hyperglycemia. At our institution, the carbohydrate-controlled breakfast diet was changed to better reflect carbohydrate goals (e.g., replacing french toast on the “bad diet” with vegetable frittatas on the “good diet”). Pre- and post-prandial glucose values for patients with types I and II diabetes receiving a carbohydrate-controlled diet were collected by retrospective chart review during the weeks before and after these changes took effect. Patients on steroids were analyzed separately. Individual post-prandial glucose values were recorded in a binary fashion as meeting or exceeding predefined glucose targets (<180 mg/dL, <250mg/dL, and <350mg/dL). During this period, 369 patients not receiving steroids and 39 patients receiving steroids had at least one relevant glucose value. In the non-steroid group, there was no difference in proportion of patients who exceeded any of the predefined thresholds. However, in the steroid group, there was a trend toward reduction in proportion of patients exceeding blood glucose of 180mg/dL (absolute risk reduction 19%, 95% confidence interval -4% to 42%, p = 0.12) and 250mg/dL (absolute risk reduction 17%, 95% confidence interval -2% to 35%, p = 0.08) on the days after the dietary change. Although all patients with diabetes may experience hyperglycemia proportionate to their carbohydrate intake, those on steroids experience induced insulin resistance leading to especially diet-sensitive glucose excursions. Our data suggests that patients receiving steroids can likely achieve improved inpatient glucose control through dietary modification. Physician and administration attention to carbohydrate-controlled menus represents an opportunity for improved quality of care for inpatients with diabetes.