14 Subsequent studies and meta-analyzes of randomized controlled trials of TGC in critically ill patients 15 - 17 have generated conflicting results with evidence pointing to higher mortality rates possibly attributable to higher hypoglycemic rates. 3 - 11 Due to the promise of early trials in critically ill patients, 12, 13 tight glycemic control (TGC) regimens in hospitals were endorsed by a number of professional organizations including the American Diabetes Association (ADA). It is now quite clear that both hyperglycemia and hypoglycemia in hospitals are associated with poorer outcomes such as increased morbidity, mortality and length of stay. In all countries, the majority of these costs were related to inpatient care-33.7%, 58.2%, 37.2%, 56.9%, and 35.8%, respectively. 1 A 5-country EU study estimated that in 2010, the total direct costs of care for people with diabetes were highest in Germany (in part due to the greater diabetes population) at €43.2 billion, followed by the UK (€20.2 billion), France (€12.9 billion), Italy (€7.9 billion) and Spain (€5.4 billion). The largest component (43%) related to inpatient care. In the United States, the annual estimated cost of treating diabetes in 2012 was $245 billion, a 41% increase from 2007.
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