***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: People with diabetes are more likely to be hospitalized and to have longer duration s of hospital stay than those without diabetes . A recent survey estimated that 22 % of all hospital inpatient days were incurred by people with diabetes and that hospital inpatient care accounted for half of the 174 billion USD total U.S. medical expenditures for this disease ( 1 ) . These findings are due , in part , to the continued expansion of the worldwide epidemic of type 2 diabetes . In the U.S. alone , there are ∼1.6 million new cases of diabetes each year , with an over all prevalence of 23.6 million people ( 7.8 % of the population , with one-fourth of the cases remaining undiagnosed ) . An additional 57 million American adults are at high risk for type 2 diabetes ( 2 ) . Although the costs of illness-related stress hyperglycemia are not known , they are likely to be considerable in light of the poor prognosis of such patients ( 3–6 ) . There is substantial observational evidence linking hyperglycemia in hospitalized patients ( with or without diabetes ) to poor outcomes . Cohort studies as well as a few early r and omized controlled trials ( RCTs ) have suggested that intensive treatment of hyperglycemia improved hospital outcomes ( 5–8 ) . In 2004 , this evidence led the American College of Endocrinology ( ACE ) and the American Association of Clinical Endocrinologists ( AACE ) , in collaboration with the American Diabetes Association ( ADA ) and other medical organizations , to develop recommendations for treatment of inpatient hyperglycemia  ( 9 ) . In 2005 , the ADA added recommendations for treatment  of hyperglycemia in the hospitalto itsannual St and ards of Medical Care ( 10 ) . Recommendations from the ACE and the ADA generally endorsed tight glycemic control in critical care units . For patients in general medical and surgical units , where RCT evidence regarding treatment targets was lacking , glycemic goals similar to those advised for out patients were advocated ( 9 , CONTEXT While glucose control is recommended by professional societies for patients with hyperglycemia hospitalized with acute myocardial infa rct ion ( AMI ) , enthusiasm for glucose lowering is tempered , in part , by concerns of inducing hypoglycemia . Yet , whether episodic hypoglycemia that occurs as a result of glucose-lowering therapy is harmful in patients with AMI is unknown . OBJECTIVE To determine whether the mortality risk associated with hypoglycemic events is similar in patients who develop hypoglycemia spontaneously and those who develop it as a result of insulin therapy .  DESIGN , SETTING , AND PATIENTS Retrospective cohort study using data from Health Facts , a contemporary data base of patients hospitalized across the United States in 40 hospitals between January 1 , 2000 , and December 31 , 2005 . Of all the patients in the data base , 7820 patients were hospitalized with AMI and were hyperglycemic on admission ( glucose level > or = 140 mg/dL ) . Patients were stratified based on whether they developed a hypoglycemic event ( r and om glucose level < 60 mg/dL ) during subsequent hospitalization . Logistic regression models were used to evaluate the association between hypoglycemia and in-hospital mortality within subgroups of patients who were and were not treated with insulin therapy . MAIN OUTCOME MEASURE All-cause in-hospital mortality . RESULTS Among patients treated or not treated with insulin , those with hypoglycemia were older and had more comorbidity . Hypoglycemia was associated with increased mortality in patients not treated with insulin ( 18.4 % [ 25/136 ] mortality in patients with hypoglycemia vs 9.2 % [ 425/4639 ] in those without hypoglycemia ; P<.001 ) , but not in those treated with insulin ( 10.4 % [ 36/346 ] mortality in patients with hypoglycemia vs 10.2 % [ 276/2699 ] in those without hypoglycemia ; P = .92 ) . After multivariable adjustment , there was a significant interaction between hypoglycemia and insulin therapy ( P value for interaction = .01 ) . Hypoglycemia was a predictor of higher mortality in patients who were not treated with insulin ( odds ratio , 2.32 [ 95 % confidence interval , 1.31 - 4.12 ] vs patients without hypoglycemia ) , but not in patients treated with insulin ( odds ratio , 0.92 [ 95 % confidence interval , 0.58 - 1.45 ] vs patients without hypoglycemia ) . CONCLUSIONS While hypoglycemia was associated with increased mortality in patients with AMI , this risk was confined to patients who developed hypoglycemia spontaneously . In contrast , iatrogenic hypoglycemia after insulin therapy was not associated with higher mortality risk Background —This study sought to determine whether tight glycemic control with a modified glucose-insulin-potassium ( GIK ) solution in diabetic coronary artery bypass graft ( CABG ) patients would improve perioperative outcomes . Methods and Results —One hundred forty-one diabetic patients undergoing CABG were prospect ively r and omized to tight glycemic control ( serum glucose , 125 to 200 mg/dL ) with GIK or st and ard therapy ( serum glucose < 250 mg/dL ) using intermittent subcutaneous insulin beginning before anesthesia and continuing for 12 hours after surgery . GIK patients had lower serum glucose levels ( 138±4 versus 260±6 mg/dL ; P < 0.0001 ) , a lower incidence of atrial fibrillation ( 16.6 % versus 42 % ; P = 0.0017 ) , and a shorter postoperative length of stay ( 6.5±0.1 versus 9.2±0.3 days ; P = 0.003 ) . GIK patients also showed a survival advantage over the initial 2 years after surgery ( P = 0.04 ) and decreased episodes of recurrent ischemia ( 5 % versus 19 % ; P = 0.01 ) and developed fewer recurrent wound infections ( 1 % versus 10 % , P = 0.03 ) . Conclusions —Tight glycemic control with GIK  in diabetic CABG patients  improves perioperative outcomes , enhances survival , and decreases the incidence of ischemic events and wound complications OBJECTIVE To describe the main findings of the Portl and Diabetic Project , which eluci date s the adverse relationship between hyperglycemia and outcomes of cardiac surgical procedures in patients with diabetes and delineates the protective effects of intravenous insulin therapy in reducing those adverse outcomes . RESULTS In this ongoing 17-year prospect i ve , nonr and omized , interventional study of 4,864 patients with diabetes who underwent an open-heart surgical procedure , we investigated the effects of hyperglycemia , and its subsequent reduction by continuous intravenous insulin ( CII ) therapy , on in-hospital outcomes . Increasing blood glucose levels were found to be directly associated with increasing rates of death , deep sternal wound infections ( DSWI ) , length of hospital stay ( LOS ) , and hospital cost . In separate multivariate analyses , increasing hyperglycemia was found to be independently predictive of increasing mortality ( P<0.0001 ) , DSWI ( P = 0.017 ) , and LOS ( P<0.002 ) . Conversely , CII therapy , design ed to achieve predetermined target blood glucose levels , independently reduced the risks of death and DSWI by 57 % and 66 % , respectively ( P<0.0001 for both ) . Target blood glucose levels of less than 150 mg/dL and a 3-day postoperative duration of CII therapy are both important variables that determine the effect of the CII therapy on improved outcomes . Coronary artery bypass grafting-related mortality ( 2.5 % ) and DSWI rates ( 0.8 % ) in patients with diabetes were normalized to those of the nondiabetic population by the use of the Portl and CII Protocol . CONCLUSION Perioperative hyperglycemia in patients undergoing a cardiac surgical procedure affects biochemical and physiologic functions , which , in turn , adversely alter mortality , LOS , and infection rates . The Portl and CII Protocol is a cost-efficient method that effectively eliminates hyperglycemia and reduces postoperative morbidity and mortality in patients with diabetes undergoing an open-heart operation . CII protocol s should be the st and ard care for glycometabolic control in all patients undergoing cardiac surgical procedures OBJECTIVE To assess the effect of an intensive glucose management protocol in a heterogeneous population of critically ill adult patients . PATIENTS AND METHODS This study consisted of 800 consecutive patients admitted after institution of the protocol ( treatment group , between February 1 , 2003 , and January 10 , 2004 ) and 800 patients admitted immediately preceding institution of the protocol ( baseline group , between February 23 , 2002 , and January 31 , 2003 ) . The setting was a 14-bed medical-surgical intensive care unit ( ICU ) in a university-affiliated community teaching hospital . The protocol involved intensive monitoring and treatment to maintain plasma glucose values lower than 140 mg/dL. Continuous intravenous insulin was used if glucose values exceeded 200 mg/dL on 2 successive occasions . RESULTS The 2 groups of patients were well matched , with similar age , sex , race , prevalence of diabetes mellitus , Acute Physiology and Chronic Health Evaluation II scores , and distribution of diagnoses . After institution of the protocol , the mean glucose value decreased from 152.3 to 130.7 mg/dL ( P<.001 ) , marked by a 56.3 % reduction in the percentage of glucose values of 200 mg/dL or higher , without a significant change in hypoglycemia . The development of new renal insufficiency decreased 75 % ( P=-.03 ) , and the number of patients undergoing transfusion of packed red blood cells decreased 18.7 % ( P=.04 ) . Hospital mortality decreased 29.3 % ( P=.002 ) , and length of stay in the ICU decreased 10.8 % ( P=.01 ) . CONCLUSION The protocol result ed in significantly improved glycemic control and was associated with decreased mortality , organ dysfunction , and length of stay in the ICU in a heterogeneous population of critically ill adult patients . These results support the adoption of this low-cost intervention as a st and ard of care for critically ill patients Diabetes is one of the most common diagnoses in hospitalized patients . A third of all persons admitted to urban general hospitals have glucose levels qualifying them for the diagnosis of diabetes , and a third of these hyperglycemic patients have not previously been diagnosed with diabetes . The impact of hyperglycemia on the mortality rate of hospitalized patients has been increasingly appreciated . Extensive evidence from observational studies indicates that hyperglycemia in patients with or without a history of diabetes is a marker of a poor clinical outcome . In addition , the results of prospect i ve r and omized trials in patients with critical illness or those undergoing coronary bypass surgery  suggest that aggressive glycemic control improves clinical outcomes including reductions in : a ) short and long-term mortality , b ) multiorgan failure and systemic infection , and c ) length of hospitalization . The importance of glycemic control is not limited to patients in critical care areas but may also apply to patients admitted to general surgical and medical wards . The development of hyperglycemia in such patients with or without a history of diabetes has been associated with prolonged hospital stay , infection , disability after hospital discharge , and death . In general-surgical patients , serum glucose 220 mg/dL on postoperative day 1 has been shown to be a sensitive , albeit nonspecific , predictor of the development of serious postoperative hospital-acquired infection . A retrospective review of 1886 admissions to a community hospital in Atlanta , Georgia , found an 18-fold increase in mortality in hyperglycemic patients without a history of diabetes and a 2.5-fold increase in mortality in patients with known diabetes compared with controls . A meta- analysis of 26 studies identified an association of admission glucose 110 mg/dL with the increased mortality of patients hospitalized for acute stroke . More recently , hyperglycemia on admission was also shown to be independently associated with adverse outcomes in patients with community acquired pneumonia . In view of the increasing evidence supporting better glycemic control in the hospital , the American Association of Clinical Endocrinologists ( AACE ) in late 2003 convened a consensus conference on the inpatient with diabetes , cosponsored or supported by other prominent professional organizations , including the Society of Hospital Medicine ( SHM ) . An expert panel agreed on and pubE D I T O R I A OBJECTIVE To identify predictors of hypoglycemic and hyperglycemic episodes in hospitalized patients with diabetes with special attention to the effectiveness of sliding scale insulin regimens . DESIGN Prospect i ve cohort study . SETTING Urban university hospital . PARTICIPANTS One hundred seventy-one adults with diabetes mellitus as a comorbid condition admitted consecutively to medical inpatient services during a 7-week period . MEASUREMENT 
    Output:
    
Protocol s targeting glucose values less than 150 mg/dL have been repeatedly associated with near elimination of sternal wound infections in patients following open heart procedures [ 3 , 13 ] .