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Managing Diabetes and Hyperglycemia in Hospitalized Patients

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eMediNexus    16 December 2022

Diabetes remains the most prevalent metabolic disorder and affects more than 460 million people globally. In the United States, 10.5% of the population suffers from diabetes. These patients have a 3-fold greater chance of hospitalization than those without diabetes. In 2016, the U.S. witnessed over 7.8 million hospital stays for patients with diabetes. Hyperglycemia, described as a blood glucose >140 mg/dl (7.8 mmol/l), occurs in 22-46% of non-critically ill hospitalized patients. Extensive data shows that inpatient hyperglycemia, in patients with or without a prior diagnosis of diabetes, is linked with an increased risk of complications and mortality. 

 

Insulin is still considered the best way to control hyperglycemia in the inpatient setting, especially in critically ill patients. Lately, the American Diabetes Association recommended target glucose between 140 mg/dl (7.8 mmol/l) and 180 mg/dl (10.0 mmol/l) for critically ill patients in the ICU and for most patients admitted to general medicine and surgery in the non-ICU setting. Intravenous insulin administration is preferred to achieve the recommended glycemic target in the ICU. Using oral antidiabetic agents was not recommended in previous guidelines due to the lack of safety and efficacy studies in the inpatient setting. Yet, increasing evidence suggests that treatment with oral agents like DPP4 inhibitors, alone or in combination with basal insulin, is safe and effective in general medicine and surgery patients with mild to moderate hyperglycemia. 

 

Dhatariya K, Corsino L, Umpierrez GE. Management of Diabetes and Hyperglycemia in Hospitalized Patients. [Updated 2020 Dec 30]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279093/

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