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Endocrine Society releases new guidelines for hospitalized patients with diabetes

The Endocrine Society has updated its guidelines for the management of hospitalized patients with diabetes or stress-induced hyperglycemia. Adult patients with diabetes or newly recognized hyperglycemia account for more than 30% of non-critically ill hospitalized patients. These patients are at increased risk of “adverse clinical outcomes in the absence of defined approaches to glycemic management,” as described in Management of hyperglycemia in patients hospitalized in non-critical care settings: clinical practice guideline from the endocrine society, which was published online in The Journal of Clinical Endocrinology and Metabolism.1

The guideline replaces the Society’s 2012 inpatient hyperglycemia guideline. Hospitalized patients who have received corticosteroid therapy or enteral nutrition are at high risk of hyperglycemia. The guidelines update some of the standards of care for glycemic management for non-severely hospitalized adult patients with diabetes using updated methodology that adheres to Institute of Medicine (IOM) standards, noted the company in a press release.2

The Endocrine Society’s guideline writing committee has identified 10 frequently encountered areas specific to blood glucose management in the hospital and made recommendations. 2012 guideline updates include hospital use of continuous glucose monitoring and insulin pump therapy for patients at high risk of hypoglycemia, and provision of diabetes education to hospitalized patients as part of a comprehensive diabetes discharge planning process, according to the society (table). In addition, the following new topics have been included:

  • Hospital use of insulin pump therapy
  • Management of hyperglycemia in patients receiving glucocorticoids or enteral nutrition
  • Use of non-insulin hypoglycemic therapies
  • Preoperative Blood Glucose Targets for Patients Undergoing Elective Surgeries
  • Specific recommendations for scheduled insulin therapy

“This guideline addresses several important aspects of care specific to the hospital management of non-critically ill patients with diabetes or newly recognized hyperglycaemia that have the potential to improve clinical outcomes in hospital as well as postoperatively. out,” said Mary Korytkowski, MD, of the University of Pittsburgh in Pittsburgh, Pennsylvania. Dr. Korytkowski is chair of the group that wrote the guideline.2


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Table. Main recommendations for the management of hyperglycaemia in hospitalized patients

Continuous glucose monitoring systems can guide effective glycemic management that reduces the risk of hypoglycemia in hospitalized patients
Patients receiving corticosteroid therapy or enteral nutrition (liquid nutrition delivered directly into the digestive system) are at high risk of hyperglycemia and require scheduled insulin therapy in the hospital
Patients using insulin pump therapy prior to hospital admission can self-administer these devices if they have the mental and physical ability to do so under the supervision of hospital staff
Diabetes self-management education provided to hospitalized patients may promote better glycemic control after discharge with reduced risk of hospital readmission
Patients with diabetes scheduled for elective surgery may have better postoperative outcomes when preoperative HbA1 C is ≤ 8% and when blood glucose values ​​in the immediate preoperative period are
When targeting hemoglobin HbA1 C
It is not recommended to provide preoperative beverages containing carbohydrates to patients with known diabetes.
Patients with newly recognized hyperglycemia or well-managed diabetes on noninsulin therapy may be treated with correctional insulin alone as initial therapy upon admission to hospital
Scheduled insulin therapy is preferred for patients with persistent blood glucose values ​​>180 mg/dL and is recommended for patients using insulin therapy prior to admission
Dipeptidyl peptidase inhibitors may be used in combination with correction insulin in some patients with type 2 diabetes who have milder degrees of hyperglycemia, provided there are no contraindications to the use of these agents.

The editorial board that developed the guideline included members of the National Institutes of Health at Bethesda; national and international diabetes experts and a member of the Diabetes Patient Advocacy Coalition. The guideline was co-sponsored by the American Association of Clinical Endocrinologists, American Diabetes Association, Association of Diabetes Care and Education Specialists, Diabetes Technology Society, and European Society of Endocrinology.

References

1. Korytkowski MT, Muniyappa R, Antinori-Lent K, et al. Management of hyperglycemia in adult patients hospitalized in non-critical care settings: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2022;dgac278. Online ahead of print. doi:10.1210/clinem/dgac278

2. The Endocrine Society Clinical Practice Guidelines provide recommendations for hospitalized patients with diabetes. Press release. The endocrine society. June 12, 2022. Accessed June 13, 2022. https://www.endocrine.org/news-and-advocacy/news-room/2022/endocrine-societys-clinical-practice-guideline-offers-recommendations