Key Points
- Hyperglycemia is a common, serious, and costly health care problem in hospitalized patients.
- Observational and randomized controlled studies indicate that improvement in glycemic control results in lower rates of hospital complications in general medicine and surgery patients.
- Implementing a standardized subcutaneous (subcut) insulin order set promoting the use of scheduled basal and nutritional insulin therapy is a key intervention in the inpatient management of diabetes.
Assessment
- The Endocrine Society (ES) recommends 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|⊕◯◯◯)
- The ES suggests admission laboratory blood glucose (BG) testing for all patients, independent of a prior diagnosis of diabetes. (2|⊕◯◯◯)
- For patients without a history of diabetes, the ES recommends bedside point of care (POC) testing for ≥ 24-48 h if BG > 7.8 mmol/L (140 mg/dL). Those with BG > 7.8 mmol/L require ongoing POC testing with appropriate therapeutic intervention. (1|⊕◯◯◯)
- The ES recommends monitoring previously normoglycemic patients receiving therapies associated with hyperglycemia — such as corticosteroids or octreotide, enteral nutrition (EN) and parenteral nutrition (PN) — with bedside POC testing for ≥ 24 to 48 h after initiation of these therapies. Those with BG measures > 7.8 mmol/L (140 mg/dL) require ongoing POC testing with appropriate therapeutic intervention. (1|⊕◯◯◯)
- The ES recommends a hemoglobin A1c (HbA1c) level in patients with known diabetes or with hyperglycemia (> 7.8 mmol/L) if this has not been performed in the preceding 2-3 months. (1|⊕◯◯◯)
Monitoring in the Noncritical Care Setting
- The ES recommends bedside capillary POC testing as the preferred method for guiding ongoing glycemic management of individual patients. (1|⊕⊕◯◯)
- The ES recommends the use of BG monitoring devices that have demonstrated accuracy in acutely ill patients. (1|⊕◯◯◯)
- The ES recommends that timing of glucose measurements matches the patient’s nutritional intake and medication regimen. (1|⊕◯◯◯)
- The ES suggests the following schedules for POC testing:
- before meals and at bedtime in patients who are eating
- every 4-6 h in patients who are NPO or receiving continuous EN. (2|⊕◯◯◯)
