Inpatient glycemic management - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Hyperglycemia and hypoglycemia are associated with higher mortality, independent of known history of diabetes. Patients with newly discovered hyperglycemia have significantly higher in-hospital mortality than patients with a known history of diabetes or normoglycemic patients.
In both critical and noncritical care settings, glycemic control should be individualized to the patient's status and to the resources available. Management is similar in medical and surgical patients, but hypoglycemia is more frequent in medical patients, and outcomes are worse in this group; therefore, avoidance of hypoglycemia is essential.
Effective management of hyperglycemia is associated with a decreased length of intensive care unit and hospital stay. An intravenous insulin infusion, along with an infusion of dextrose, is the preferred method of delivering insulin in critically ill patients. Tight glycemic control in the normal range of 80-110 mg/dL (4.4 to 6.1 mmol/L) may not be necessary, however, and may in fact be harmful.
A basal-bolus insulin regimen or a basal insulin regimen may be used in patients admitted to the hospital who are not critically ill. Sliding scale insulin alone should not be used in these patients.

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Citations

Key Articles

American Diabetes Association. Standards of care in diabetes - 2024. Diabetes Care. 2024 Jan;47(suppl 1):S1-321.[Full Text]
Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract 2009 May-Jun;15(4):353-69.[Abstract]
Pasquel FJ, Lansang MC, Dhatariya K, et al. Management of diabetes and hyperglycaemia in the hospital. Lancet Diabetes Endocrinol. 2021 Mar;9(3):174-88.[Abstract][Full Text]
Finfer S, Chittock DR, Su SY, et al; NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009 Mar 26;360(13):1283-97.[Abstract][Full Text]
Umpierrez G, Smiley D, Zisman A, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care. 2007 Sep;30(9):2181-6.[Abstract][Full Text]

Referenced Articles

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35. Adams G, Hunter J, Langley J, et al. Is nurse-managed blood glucose control in critical care as safe and effective as the traditional sliding scale method? Intensive Crit Care Nurs. 2009 Dec;25(6):294-305.[Abstract]
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