Updated clinical guidelines on glycemic management in hospitalized, noncritically ill adult patients who have diabetes or newly recognized hyperglycemia were published in June 2022 by the Endocrine Society (ES), in The Journal of Clinical Endocrinology & Metabolism.[1,2]
In hospital settings with available resources and training, real-time continuous glucose monitoring (CGM) is suggested for hospitalized, noncritically ill adults with insulin-treated diabetes and a high risk for hypoglycemia. Confirmatory bedside point-of-care blood glucose monitoring should be used to adjust insulin dosing instead of employing only point-of-care blood glucose testing.
Glycemic therapy employing either neutral protamine Hagedorn (NPH)–based insulin or basal bolus insulin regimens is suggested for hospitalized, noncritically ill adults who experience hyperglycemia (blood glucose >140 mg/dL [7.8 mmol/L]) while glucocorticoids are being administered.
It is suggested that when a hospital can access personnel with expertise in insulin pump treatment, such therapy be continued in adult patients whose diabetes was being managed with an insulin pump before admission for noncritical illness. This strategy should be used in place of putting the patient on subcutaneous basal bolus insulin therapy. In situations where expertise is not accessible and the patient’s anticipated length of stay in the hospital is greater than 1-2 days, it is suggested that the patient undergo transition to scheduled subcutaneous basal bolus insulin prior to discontinuation of an insulin pump.
It is suggested that in adult patients with diabetes who are undergoing elective surgical procedures, a preoperative hemoglobin A1c (HbA1c) level of less than 8% (63.9 mmol/mol) be targeted, along with a blood glucose concentration of 100-180 mg/dL (5.6-10 mmol/L).
NPH-based or basal bolus regimens are suggested in hospitalized, noncritically ill adult patients in whom enteral nutrition, using formulations that are specific or nonspecific for diabetes, is being administered
It is suggested that scheduled insulin therapy rather than noninsulin glycemic management therapies be used in most hospitalized, noncritically ill adult patients with hyperglycemia (with or without known type 2 diabetes).
It is suggested that carbohydrate-containing oral fluids not be administered preoperatively to adults with type 1 diabetes, type 2 diabetes, or other forms of diabetes, in whom a surgical procedure is being performed.
It is suggested that carbohydrate counting not be used to calculate prandial insulin doses in hospitalized, noncritically ill adult patients with noninsulin-treated type 2 diabetes in whom prandial insulin therapy is required.
It is suggested that either carbohydrate counting be used or, with fixed prandial insulin dosing, no carbohydrate counting be employed, in hospitalized, noncritically ill adult patients with type 1 diabetes or insulin-treated type 2 diabetes.
It is suggested that in maintaining glucose targets of 100-180 mg/dL (5.6-10 mmol/L), initial therapy with correctional insulin be employed over scheduled insulin therapy (ie, basal or basal/bolus insulin) in hospitalized, noncritically ill adults with no prior history of diabetes who, during hospitalization, experience hyperglycemia. It is also suggested that scheduled insulin therapy be added in patients with persistent hyperglycemia, that is, those who, having received correctional insulin alone, have two or more point-of-care blood glucose measurements of 180 mg/dL or greater in a 24-hour period.
For more information, please go to Hyperglycemia and Hypoglycemia in Stroke, Type 1 Diabetes Mellitus, and Type 2 Diabetes Mellitus.
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Cite this: Hyperglycemia Clinical Practice Guidelines (ES, 2022) - Medscape - Aug 08, 2022.