Cardiovascular Risk in Diabetes Mellitus: Cause and Effect

• Published in: Current emergency and hospital medicine reports 2014-03, Vol.2 (1), p.16-25
• Main Authors: Pollack, Charles V., Ford, William T., Volturo, Gregory, Badlani, Sameer, Yu, David J., Brogan, Gerard X.
• Format: Article
• Language: English
• Subjects: Atherosclerosis; Cardiovascular disease; Collaboration; Diabetes; Diabetes and Metabolic Disease (W Ford; Disease prevention; Emergency medical care; Emergency Medicine; Epidemiology; Glucose; Hospitalists; Insulin resistance; Kinases; Medicine; Medicine & Public Health; Metabolism; Mortality; Obesity; Pathophysiology; Patients; Risk factors; Section Editor
• ISSN: 2167-4884; 2167-4884
• DOI: 10.1007/s40138-013-0034-2

In the care of the diabetic patient being admitted to the hospital from the emergency department (ED), there is an opportunity to provide a smoother transition of care by recognizing that the first 6–12 h of care have an important impact on the outcomes and overall length of hospital stay. This is especially true when an inpatient bed is not immediately available for transfer and the burden of initial care falls on the emergency physician and nurses. Although it varies across the country, for many patients, the first 12 or more hours of “inpatient care” may be spent in the ED, representing perhaps as much as one-third of the entire hospital stay. With the rapid growth and influence of Accountable Care Organizations and focus on value over volume, length of stay is more critical than ever. It is more important to initiate the correct dose of insulin, along with a thorough evaluation of the diabetic patient’s other medications with the aim to stabilize the patient for a more effective hand-off to the hospitalist, cardiologist, surgeon, or any other inpatient provider. The value of this type of coordinated care is enhanced in patients who also have cardiovascular disease (CVD) because of the benefits associated with optimal glycemic control. In this article, we will review the current definition of optimal glycemic control as it applies to the patient with diabetes who also has cardiovascular disease, in order to highlight procedural changes that can be made to facilitate overall quality care. Underlying this call for a new focus is the observation that the impact of tighter glycemic control on outcomes in CVD such as acute coronary syndrome, heart failure, sepsis, and stroke cannot be underestimated.