8
Recommendation 7.1
➤ In most adult patients with hyperglycemia (with or without known type
2 diabetes [T2D]) hospitalized for a non-critical illness, we suggest that
scheduled insulin therapy be used instead of non-insulin therapies for
glycemic management. (2|⊕⊕
)
Remarks:
▶ Dipeptidyl peptidase-4 inhibitors (DPP4is) may be appropriate in select patients
with T2D (see Recommendation 7.2), including those with established non-insulin–
requiring diabetes nearing hospital discharge.
▶ It may be reasonable to begin other non-insulin therapies in stable patients prior to
discharge as a part of a coordinated transition plan.
Recommendation 7.2
➤ In select adult patients with mild hyperglycemia and T2D hospitalized
for a non-critical illness, we suggest using either DPP4i with correction
insulin or scheduled insulin therapy. (2|⊕⊕
)
Remarks:
▶ Select patients include those with T2D that is moderately well-managed as reflected by a
recent HbA1c <7.5% (9.4 mmol/L); BG <180 mg/dL (10 mmol/L); and, if on insulin
therapy before hospitalization, to have a total daily insulin dose <0.6 units/kg/day; this
recommendation applies both to patients taking the DPP4i before admission and those
who are not.
▶ Patients who develop persistently elevated BG (e.g., >180 mg/dL [10 mmol/L])
on DPP4i therapy should be managed with scheduled insulin therapy; this
recommendation does not apply to patients with T1D or other forms of insulin-
dependent diabetes.
▶ As with all new therapies started in the hospital, a discussion with the patient about cost
and overall acceptability is suggested if there are plans to continue the medication after
discharge.
Recommendation 8.1
➤ In adult patients with type 1 diabetes (T1D), T2D, and other forms of
diabetes undergoing surgical procedures, we suggest not administering
CHO-containing oral fluids preoperatively. (2|⊕
)
Recommendation 9.1
➤ In adult patients with non-insulin treated T2D hospitalized for non-
critical illness who require prandial insulin therapy, we suggest not CC
for calculating prandial insulin doses. (2|⊕
)
Recommendation 9.2
➤ In adult patients with T1D, insulin-treated T2D hospitalized for non-
critical illness, we suggest either CC or no CC with fixed prandial
insulin dosing. (2|⊕
)
Treatment
