Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting

We recommend that clinicians assess all patients admitted to the hospital for a history of diabetes. When present, this diagnosis should be clearly identified in the medical record. (1, VL)

We suggest that all patients, independent of a prior diagnosis of diabetes, have laboratory blood glucose (BG) testing on admission. (2, VL)

We recommend that patients without a history of diabetes with BG greater than 7.8 mmol/liter (140 mg/dl) be monitored with bedside point of care (POC) testing for at least 24 to 48 h. Those with BG greater than 7.8 mmol/liter require ongoing POC testing with appropriate therapeutic intervention. (1, VL)

We recommend that in previously normoglycemic patients receiving therapies associated with hyperglycemia, such as corticosteroids or octreotide, enteral nutrition (EN) and parenteral nutrition (PN) be monitored with bedside POC testing for at least 24 to 48 h after initiation of these therapies. Those with BG measures greater than 7.8 mmol/liter (140 mg/dl) require ongoing POC testing with appropriate therapeutic intervention. (1, VL)

We recommend that all inpatients with known diabetes or with hyperglycemia (>7.8 mmol/liter) be assessed with a hemoglobin A1C (HbA1C) level if this has not been performed in the preceding 2–3 months. (1, VL)