Treatment

Document Overview

Design and created by Guideline Central in participation with the Endocrine Society.

Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings

Endocrine Society

Publication Date: Jun 11, 2022

Page Last Updated: May 5, 2026

Recommendation 3.1

In adult patients using insulin pump therapy for diabetes management prior to admission for non-critical illness, we suggest that these patients continue insulin pump therapy rather than changing to subcutaneous (SC) BBI therapy in hospitals with access to personnel with expertise in insulin pump therapy. Where expertise is not accessible, we suggest that patients with anticipated hospital length of stay (LOS) of more than 1–2 days be transitioned to scheduled SC BBI before discontinuation of an insulin pump. ( Low, 2 – Conditional recommendation )

Remarks:

Patients with an impaired level of consciousness, inability to appropriately adjust pump settings, critical illness (intensive care unit [ICU] care), diabetic ketoacidosis, or hyperosmolar hyperglycemic state are not candidates for inpatient use of the insulin pump. Any change in a patient’s condition that would interfere with their ability to safely self-manage the insulin pump device requires removal and transition to SC therapy (Table 3). Availability of supplies (provided by the patient or patient’s family) over the course of the hospitalization is necessary. Adaptation of the basal rate might be needed at time of admission.
Patients using hybrid closed loop insulin pump therapy may be able to continue this at time of admission if they meet criteria similar to that for patients using insulin pump therapy independently of a CGM device as long as the CGM and insulin pump are able to function without interference with hospital care. If CGM fails or is removed from the patient, the insulin pump can be reverted to manual mode as long as basic criteria for pump use in hospital are still met.
Hospitals need to have policies, procedures including patients’ informed consent, and standardized order sets in place as well as expertise from a health care professional who is knowledgeable in insulin pump therapy. These policies and procedures should include information for management of insulin pump devices during magnetic resonance imaging, computed tomography, or other imaging studies, in addition to any surgical procedures.

GRADE Classification of Guideline Recommendations, Strength of Recommendation Classifications and Interpretation

GRADE Classification of Guideline Recommendations

Certainty of Evidence	Interpretation
High ⊕⊕⊕⊕	We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate ⊕⊕⊕o	We are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low ⊕⊕oo	Our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.
Very Low ⊕ooo	We have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

Reprinted from Eds. Schünemann H, Brożek J, Guyatt G, and Oxman A. GRADE Handbook: Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. Updated October 2013.

GRADE Strength of Recommendation Classifications and Interpretation

Strength of recommendation	Criteria	Interpretation by patients	Interpretation by health care providers	Interpretation by policy makers
1 – Strong recommendation for or against	Desirable consequences CLEARLY OUTWEIGH the undesirable consequences in most settings (or vice versa).	Most individuals in this situation would want the recommended course of action, and only a small proportion would not.	Most individuals should receive the recommended course of action. Adherence to this recommendation according to the guidelines could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.	The recommendation can be adopted as policy in most situations.
2 – Conditional recommendation for or against	Desirable consequences PROBABLY OUTWEIGH undesirable consequences in most settings (or vice versa).	The majority of individuals in this situation would want the suggested course of action, but many would not.	Clinicians should recognize that different choices will be appropriate for each individual and that clinicians must help each individual arrive at a management decision consistent with the individual’s values and preferences. Decision aids may be useful to help individuals make decisions consistent with their values and preferences.	Policy-making will require substantial debate and involvement of various stakeholders.

Adapted from Schünemann HJ et al. Blood Adv, 2018; 2(22) © by The American Society of Hematology.

Document Overview

Document Title: Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings

Authoring Society: Endocrine Society

Document Publication Date: Jun 11, 2022

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: academic.oup.com/jcem/article/107/8/2101/6605637

Source Citation: Korytkowski MT, Muniyappa R, Antinori-Lent K, et al. Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, J Clin Endocrinol Metab. 2022, 107(8).

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: To review and update the 2012 Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline and to address emerging areas specific to the target population of noncritically ill hospitalized patients with diabetes or newly recognized or stress-induced hyperglycemia.

Scope: Management, Treatment

Diseases/Conditions (MeSH)

D003920 - Diabetes Mellitus

D006943 - Hyperglycemia

D003920 - Diabetes Mellitus

D006943 - Hyperglycemia

Keywords: Continuous Glucose Monitoring, diabetes mellitus, hospital care, hyperglycemia, insulin pump

Target Patient Population: Patients with diabetes mellitus hospitalized in non-critical care setting

Target Provider Population: Endocrinologists, Internal Medicine Providers, Hospitalists

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Hospital

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

Should continuous glucose monitoring (with confirmatory point-of-care blood glucose monitoring for adjustments in insulin dosing) vs bedside capillary blood glucose monitoring be used for adults with diabetes hospitalized for noncritical illness?
Should neutral protamine Hagedorn insulin regimens vs basal bolus insulin regimens be used for adults with hyperglycemia (with and without known diabetes) hospitalized for noncritical illness receiving glucocorticoids?
Should continuous subcutaneous insulin infusion pump therapy be continued vs transitioning to scheduled subcutaneous insulin therapy for adults with diabetes on pump therapy who are hospitalized for noncritical illness?
Should inpatient diabetes education be provided vs not provided before discharge for adults with diabetes hospitalized for noncritical illness?
Should prespecified preoperative blood glucose and/or hemoglobin A1c levels be targeted for adults with diabetes undergoing elective surgical procedures?
Should basal or basal bolus insulin vs neutral protamine Hagedorn insulin be used for adults hospitalized for noncritical illness receiving enteral nutrition with diabetes-specific and nonspecific formulations?
Should noninsulin therapies [metformin, sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors] vs scheduled insulin therapies be used for adults with hyperglycemia [with and without known type 2 diabetes] hospitalized for noncritical illness?
Should caloric carbohydrate containing oral fluids vs noncaloric beverages be used preoperatively for adults with diabetes undergoing planned elective surgical procedures?
Should carbohydrate counting for prandial insulin dosing vs no carbohydrate counting (other insulin-dosing regimen) be used for adults with diabetes hospitalized for noncritical illness?
Should correctional insulin vs correctional insulin and scheduled insulin therapy (as basal bolus insulin or basal insulin with correctional insulin) be used for adults with hyperglycemia (with and without known diabetes) hospitalized for noncritical illness?

Supplemental Methodology Resource: Systematic Review Document

Number of Source Documents: 136

Literature Search Start Date: Tuesday, June 30, 2020

Literature Search End Date: Tuesday, November 30, 2021

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings

Treatment

Recommendation 1.1

Recommendation 2.1

Recommendation 3.1

Recommendation 4.1

Recommendation 5.1

Recommendation 5.2

Recommendation 6.1

Recommendation 7.1

Recommendation 7.2

Recommendation 8.1

Recommendation 9.1

Recommendation 9.2

Recommendations 9.1 and 9.2

Recommendation 10.1

Recommendation 10.2

Recommendation 10.3

GRADE Classification of Guideline Recommendations, Strength of Recommendation Classifications and Interpretation

GRADE Classification of Guideline Recommendations

GRADE Strength of Recommendation Classifications and Interpretation

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology