The Endocrine Society has issued clinical practice
guidelines on the management of hyperglycemia in patients hospitalized in a
noncritical care setting.
According to its recommendations, all patients
independent of a prior diagnosis of diabetes should have their blood
glucose levels tested upon hospital admission.
Hyperglycemia is associated with prolonged
hospital stay, increased incidence of infections and death in noncritically ill
hospitalized patients, Guillermo Umpierrez, MD, of Emory
University in Atlanta, and chair of the task force that wrote the guidelines,
said in a press release. This new guideline contains consensus
recommendations from experts in the field for the management of hyperglycemia
in hospitalized patients in noncritical care settings.
Recommendations from the Society include:
- Glycemic targets should be as follows: premeal glucose
target of less than 140 mg/dL and a random blood glucose of less than 180 mg/dL
for most hospitalized patients with a noncritical illness.
- All patients with diabetes who are treated with insulin at home should
be treated with a scheduled subcutaneous insulin regimen in the hospital.
- All patients with type 1 diabetes and most with type 2 diabetes who
undergo surgical procedures should receive either IV continuous insulin
infusion or subcutaneous basal insulin, with bolus insulin as required, to
prevent hyperglycemia during the perioperative period.
- All patients with high glucose values at admission, and in those with
or without a history of diabetes receiving nutrition via IV or a feeding tube,
should undergo bedside point-of-care glucose testing.
- All patients with type 1 and type 2 diabetes should be transitioned to
scheduled subcutaneous therapy at least 1 to 2 hours before discontinuing IV
continuous insulin infusion.
A companion patient guide to the
guidelines has been made available by the Hormone Foundation, the patient
education affiliate of The Endocrine Society. The guide explains the causes and
effects of hyperglycemia and discusses treatment options.