The Importance of Diabetes Research in Hospitalized Patients

Guillermo Umpierrez, MD, CDE, FACP, FACE, professor of medicine in the division of endocrinology, metabolism at Emory University School of Medicine, chief of diabetes and endocrinology at Grady Memorial Hospital, and the director of Atlanta Clinical & Translational Science Institute's (ACTSI) clinical research site at Grady

Diabetes is a common disease that affects more than 340 million people worldwide and an estimated 29.1 million in the U.S. – these numbers are expected to rise. Diabetes affects how your body uses glucose. Glucose, otherwise known as blood sugar, is vital to health because it is an important source of energy for the cells in muscles and tissues, and is the brain’s primary source of fuel. Diabetes means excess glucose in the blood, which can lead to serious health problems, including higher risk for heart disease and blindness, Alzheimer’s, kidney damage and failure, nerve damage and circulation problems leading to amputation, skin complications, and dental disease. Patients with this disease have a three-fold greater chance of hospitalization compared with those without diabetes.

Hyperglycemia is indicated by abnormally high blood glucose levels. Observational studies have indicated that there exists a prevalence of this condition in more than 28% of community hospitals, in up to 70% of diabetic patients with acute coronary syndrome, and approximately 80% of cardiac surgery patients in the perioperative period. Hyperglycemia continues to be frequently overlooked in critically ill patients in both general medicine and surgery services, as hyperglycemia results from acute metabolic and hormonal changes associated with the response to injury and stress. A Grady/Emory research team lead by Guillermo Umpierrez, MD, CDE, FACP, FACE, professor of medicine in the division of endocrinology, metabolism at Emory University School of Medicine, chief of diabetes and endocrinology at Grady Memorial Hospital, and the director of Atlanta Clinical & Translational Science Institute’s (ACTSI) clinical research site at Grady, over the last decade have conducted several landmark research studies on the treatment of diabetes and high blood sugar in the hospital. ACTSI sponsors the diabetes research program providing support for collecting blood samples and the space to follow a large number of research patients with diabetes.

The studies have found that treatment of high blood sugar results in lower risk of complications. Insulin is the best way to control high blood sugar in the hospital. Continued insulin therapy and management of the diabetes in the critical care setting and in surgical and general medicine settings is necessary for improved control of high blood sugar and reducing the risk of infection and complications. Finally, the team also reported on different insulin and noninsulin-based treatments for the management of high blood sugar and diabetes in hospital patients.

Umpierrez is a member of the National Board of Directors for the American Diabetes Association and the American Association Clinical Endocrinologists, as well as the Endocrine Society Clinical Guideline Committee and the American Association Clinical Endocrinologists Diabetes Scientific Council. He heads the Emory Latino Diabetes Education Program (ELDEP), the community-based diabetes education program targeting Latinos in metro Atlanta and throughout the state of Georgia, the first nationally accredited all Spanish diabetes education program dedicated to providing diabetes education and lifestyle intervention to Latinos in Georgia. His research interests include mechanisms for Beta-cell dysfunction in minority populations with ketosis-prone type 2 diabetes, the effects of free fatty acids on insulin secretion and hypertension in obese patients, and the inpatient management of insulin in critical and non-critical patients.

ACTSI is a city-wide partnership between Emory, Morehouse School of Medicine, and Georgia Tech and is one of over 60 in a national consortium striving to improve the way biomedical research is conducted across the country. The consortium, funded through the National Center for Advancing Translational Sciences (NCATS) and the National Institutes of Health’s Clinical and Translational Science Awards, shares a common vision to translate laboratory discoveries into treatments for patients, engage communities in clinical research efforts, and train the next generation of clinical investigators.

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