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The economics of glycemic control in the ICU in the United States

Scurlock, Coreya; Raikhelkar, Jayashreea; Mechanick, Jeffrey Ib

Current Opinion in Clinical Nutrition & Metabolic Care: March 2011 - Volume 14 - Issue 2 - p 209–212
doi: 10.1097/MCO.0b013e3283437bc4
Nutrition and the intensive care unit: Edited by Mette Berger and Jeffrey I. Mechanick

Purpose of review: Currently the USA has an aging population, with increasing deficits and a healthcare system that most would agree is in need of repair. Finding ways to curtail costs is urgently needed. Attention to glycemic control and metabolic care offers a cost-effective method of treatment to reduce complications.

Recent findings: Healthcare-related expenses occupy an expanding portion of gross domestic product in the US and are a driver of the deficit. Despite all of this spending, the US receives average marks on outcomes and is not obtaining value in its healthcare. Any movements toward healthcare reform must focus on improving outcomes per healthcare dollar spent, and increasing value. The Affordable Care Act will place greater emphasis on preventing complications and reducing hospital-acquired infections. The original Leuven trial demonstrated that proper implementation of glycemic control can reduce morbidity and mortality. More recent studies have shown that there is a cost-benefit to glycemic control as well, through reduction of hospital stay and prevention of complications. On the basis of these changes, physicians who practice metabolic care and provide glycemic control are well positioned to add value in this era of healthcare reform.

Summary: Glycemic control is inherently valuable in the care of ICU patients as it decreases infectious complications, reduces lengths of stay, and has a positive effect on morbidity and mortality. Further studies should be completed to delineate the exact amount of cost-savings that can be obtained by proper implementation of glycemic control in the ICU.

aDepartment of Anesthesiology, Division of Critical Care, Cardiothoracic Intensive Care Unit, USA

bDepartment of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Mount Sinai School of Medicine, New York, New York, USA

Correspondence to Corey Scurlock, MD, MBA, Assistant Professor of Anesthesiology and Cardiothoracic Surgery, Director Cardiothoracic Intensive Care Unit, Mount Sinai School of Medicine, New York, NY, USA Tel: +1 917 608 5303; fax: +1 212 876 4975; e-mail: Corey.Scurlock@mountsinai.org

© 2011 Lippincott Williams & Wilkins, Inc.