Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Setting: And Endocrine Society Clinical Practice Guideline  

Mary T Korytkowski, Ranganath Muniyappa, Kellie Antinori-Lent, Amy C Donihi, Andjela T Drincic, Irl B Hirsch, Anton Luger, Marie E McDonnell, M Hassan Murad, Craig Nielsen, Claire Pegg, Robert J Rushakoff, Nancy Santesso, Guillermo E Umpierrez. The Journal of Clinical Endocrinology & Metabolism, dgac278, https://doi.org/10.1210/clinem/dgac278. Published: 12 June 2022

Some key take-aways and items to look for: 

• 30% of patients in non-critical care hospital settings either have diabetes or develop hyperglycemia during hospitalization. Hyperglycemia compromises outcomes for hospitalized patients for all diagnoses and procedures. Traditional guidelines/protocols focus on critically ill hospitalized patients. 
• Recommendations include the use of diabetes technology (CGMs, pumps) when appropriate, which means protocols need to be in place, skilled support available and the patient's condition is appropriate. i.e., there are not skin issues. 
• A recommendation of basal-bolus insulin regimen or NPH-based regimen for patients receiving corticosteroids, which is more proactive and likely to correct the hyperglycemia crisis that often accompanies steroid therapy. 
• A recommendation to use insulin (for most patients) in hyperglycemia management over non-insulin therapies. Note: It's important to prep patients with type 2 diabetes that hospital admissions may require insulin therapy even if they take pills at home.
• A recommendation to treat patients who may need tube feeding proactively with NPH-based or basal-bolus insulin regiments.