The Mealtime Challenge: Nutrition and Glycemic Control in the Hospital

Management of diabetes and hyperglycemia has become an important quality care indicator in the hospital setting. Multiple health care organizations offer guidelines for glycemic control, including recommendations for medical nutrition therapy (MNT) and consistent-carbohydrate meal plans.1–4 Additionally, the appropriate timing of nutrition delivery, point-ofcare (POC) blood glucose monitoring, and insulin therapy in the hospital is recognized as a crucial step in the safe and effective care of patients.3,5 Although these goals are essential to reducing harm and improving outcomes, how to achieve them can be a challenge for hospitals. A quality improvement approach with strong administrative support and a multidisciplinary steering committee is needed to improve the quality of patient care.2,3,6 This article summarizes nutrition therapy goals and recommendations for glycemic control in noncritically ill, hospitalized patients; reviews the rationale for consistent-carbohydrate meal plans and liberalizing the “diabetic diet;” and describes successful mealtime practices to improve coordination of meal delivery with blood glucose monitoring and insulin administration. Results from an informal survey of inpatient diabetes educators and registered dietitians (RDs) regarding current hospital meal service practices are also included.