7
Recommendation 4.1
➤ In adult patients with diabetes who are hospitalized for non-critical
illness, we suggest providing inpatient diabetes education as part of a
comprehensive diabetes discharge-planning process, rather than not
providing inpatient diabetes education. (2|⊕⊕⊕
)
Remarks:
▶ Inpatient diabetes education is best provided by diabetes care and education specialists
(DCESs). Where availability of DCESs is limited, DCESs can serve as a resource to
healthcare providers specifically tasked to provide inpatient diabetes education (e.g., staff
nurses, pharmacists, dieticians, etc.) by providing training and support.
▶ Ideally, the DCESs should be Certified Diabetes Care and Education Specialists
(CDCESs) and/or hold the Board Certified-Advanced Diabetes Management (BC-
ADM) credential or be working toward one of these certifications.
▶ A comprehensive diabetes discharge-planning process includes education on and
validation of diabetes survival skills, referral for outpatient DSMES, scheduling diabetes
care follow-up appointments, and ensuring access to the medications and supplies
required for diabetes self-management following discharge.
▶ In the case of limited personnel, healthcare providers providing diabetes education could
prioritize education for patients at high risk for hospital readmission, those admitted
for diabetes-related issues, and those newly diagnosed with diabetes or newly starting
insulin.
Recommendation 5.1
➤ For adult patients with diabetes undergoing elective surgical procedures,
we suggest targeting preoperative HbA1c levels <8% (63.9 mmol/mol)
and BG concentrations 100–180 mg/dL (5.6–10 mmol/L). (2|⊕
)
Recommendation 5.2
➤ For adult patients with diabetes undergoing elective surgical procedures
when targeting HbA1c to <8% (63.9 mmol/mol) is not feasible, we
suggest targeting preoperative BG concentrations 100–180 mg/dL
(5.6–10 mmol/L). (2|⊕
)
Remarks:
▶ These recommendations apply only to patients who are scheduled for elective surgical
procedures for whom it would be reasonable to allow time for implementation of
therapies that target either a preoperative HbA1c or BG level.
▶ BG concentrations should be within the targeted range of 100–180 mg/dL (5.6–10
mmol/L) 1–4 hours prior to surgery.
▶ Factors that may affect HbA1c levels such as anemia, hemoglobinopathies, chronic renal
failure, alcoholism, drugs and large BG variations should be taken into account.
Recommendation 6.1
➤ In adult patients hospitalized for non-critical illness who are receiving
enteral nutrition with diabetes-specific and non-specific formulations, we
suggest using NPH-based or basal bolus regimens. (2|⊕
)
