Hyperglycemia in Hospitalized Adult Patients

Publication Date: June 12, 2022

Essential Points

Essential Points

  • Continuous glucose monitoring systems can effectively achieve glycemic targets and reduce hypoglycemia in hospitalized patients.
  • Patients receiving glucocorticoid therapy or enteral nutrition are at high risk for hyperglycemia and require scheduled insulin therapy in the hospital.
  • Patients using insulin pump therapy before hospital admission may self-manage these devices with oversight by hospital personnel.
  • Diabetes self-management education to hospitalized patients can promote improved glycemic control with reductions in the risk for hospital readmission.
  • Patients with diabetes scheduled for elective surgery may have improved postoperative outcomes when pre-operative hemoglobin A1c (HbA1c) is ≤8% and when blood glucose (BG) values in the immediate pre-operative period are <180 mg/dL.
  • Providing pre-operative carbohydrate containing beverages to patients with known diabetes is not recommended.
  • Patients with newly recognized hyperglycemia or well-managed diabetes on non-insulin therapy may be treated with correctional insulin alone as initial therapy at hospital admission.
  • Scheduled insulin therapy is preferred for patients experiencing persistent blood glucose values >180 mg/dL.
  • Dipeptidyl peptidase inhibitors can be used in combination with correction insulin in selected patients with type 2 diabetes who have milder degrees of hyperglycemia provided there are no contraindications to the use of these agents.

Definitions of Terms Used

...itions of Terms U...

...ding scale insulin (SSI): Reactive approac...


Treatment

...atment...

...Currently Available Injectable Ins...


...tion 1.1In adults with insulin-treated diab...


Table 2. Resources Required for Safe Implemen...


...dology for Converting Insulin Pump Th...


...n 2.1In adult patients who are hospitali...


Recommendation 3.1In adult patients using ins...


...ommendation 4.1In adult patients with diabe...


...tion 5.1For adult patients with diabetes undergoi...


...ndation 5.2For adult patients with diabetes und...


...6.1In adult patients hospitalized for no...


...ecommendation 7.1In most adult patients with hyper...


...mendation 7.2In select adult patients with mi...


...8.1In adult patients with type 1 diabetes...


...ation 9.1In adult patients with non-insu...


...n 9.2In adult patients with T1D, insulin-t...


Recommendations 9.1 and 9.2Remarks...


...dation 10.1In adults with no prior history...


...ecommendation 10.2In adults with diabetes t...


...n 10.3In adults with insulin-treated...