Key Points
ÎHyperglycemia is a common, serious, and costly health care problem in hospitalized patients.
ÎObservational and randomized controlled studies indicate that improvement in glycemic control results in lower rates of hospital complications in general medicine and surgery patients.
ÎImplementing 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
ÎThe 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|⊕)
ÎThe ES suggests admission laboratory blood glucose (BG) testing for all patients, independent of a prior diagnosis of diabetes. (2|⊕)
ÎFor 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|⊕)
ÎThe 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|⊕)
ÎThe 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
ÎThe ES recommends bedside capillary POC testing as the preferred method for guiding ongoing glycemic management of individual patients. (1|⊕⊕)
ÎThe ES recommends the use of BG monitoring devices that have demonstrated accuracy in acutely ill patients. (1|⊕)
ÎThe ES recommends that timing of glucose measurements matches the patient's nutritional intake and medication regimen. (1|⊕)
ÎThe 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|⊕)
