Key Points
Î Hyperglycemia is a common, serious, and costly health care problem in
hospitalized patients.
Î Observational and randomized controlled studies indicate that improvement
in glycemic control results in lower rates of hospital complications in
general medicine and surgery patients.
Î Implementing a standardized subcutaneous (subcut) insulin order set
promoting the use of scheduled basal and nutritional insulin therapy is a
key intervention in the inpatient management of diabetes.
Assessment
Î The Endocrine Society (ES) recommends that clinicians assess all patients
admitted to the hospital for a history of diabetes. When present, this
diagnosis should be clearly identified in the medical record. (1|⊕
)
Î The ES suggests admission laboratory blood glucose (BG) testing for all
patients, independent of a prior diagnosis of diabetes. (2|⊕
)
Î For patients without a history of diabetes, the ES recommends bedside
point of care (POC) testing for ≥ 24-48 h if BG > 7.8 mmol/L (140 mg/dL).
Those with BG > 7.8 mmol/L require ongoing POC testing with appropriate
therapeutic intervention. (1|⊕
)
Î The ES recommends monitoring previously normoglycemic patients
receiving therapies associated with hyperglycemia — such as corticosteroids
or octreotide, enteral nutrition (EN) and parenteral nutrition (PN) — with
bedside POC testing for ≥ 24 to 48 h after initiation of these therapies.
Those with BG measures > 7.8 mmol/L (140 mg/dL) require ongoing POC
testing with appropriate therapeutic intervention. (1|⊕
)
Î The ES recommends a hemoglobin A1c (HbA1c) level in patients with
known diabetes or with hyperglycemia (> 7.8 mmol/L) if this has not been
performed in the preceding 2-3 months. (1|⊕
)
Monitoring in the Noncritical Care Setting
Î The ES recommends bedside capillary POC testing as the preferred method
for guiding ongoing glycemic management of individual patients. (1|⊕⊕
)
Î The ES recommends the use of BG monitoring devices that have
demonstrated accuracy in acutely ill patients. (1|⊕
)
Î The ES recommends that timing of glucose measurements matches the
patient's nutritional intake and medication regimen. (1|⊕
)
Î The ES suggests the following schedules for POC testing:
• before meals and at bedtime in patients who are eating
• every 4-6 h in patients who are NPO or receiving continuous EN. (2|⊕
)
