Management of hyperglycemia in non critical hospitalized patients

Abstract

Several observational studies suggest a strong association between inpatient hyperglycemia (with or without diabetes) and adverse clinical outcomes, including prolonged hospitalization, infection, disability after hospital discharge and death. The American Association of Clinical Endocrinologists (AACE) and American Diabetes Association (ADA) suggest that insulin therapy is initiated for the treatment of persistent hyperglycemia from glucose levels of 180mg/dL. For most noncritically inpatients, usually the goal of premeal blood glucose should be <140mg/dL and random blood glucose < 180mg/dL. The scheme of basal-bolus insulin, in combination with corrective or additional doses to control premeal hyperglycemia is the recommended approach. Discharge planning, patient education and clear communication with outpatient providers are critical for ensuring a safe transition to outpatient glycemic management.