Diabetes Care in Hospital Settings
- Introduction
Hyperglycemia, hypoglycemia and blood glucose variability are frequently observed in hospitalized individuals, regardless of whether they have diabetes or not. This condition is prevalent among both medical and surgical patients and is associated with adverse health outcomes. Patients with dysglycemia are very prone to different complications such as pneumonia, acute renal failure, sepsis, urinary tract infections, prolonged hospital stays, and post-admission disability. These complications contribute to increased morbidity and mortality rates. The pathophysiology of hyperglycemia in hospitalized patients involves several mechanisms. During stressful situations like hospitalization, there is an excessive secretion of counter-regulatory hormones such as glucagon, growth hormone, epinephrine, and cortisol, which elevate blood glucose levels by promoting hepatic glucose production. Additionally, the overproduction of pro-inflammatory cytokines disrupts carbohydrate metabolism and reduces the peripheral utilization of glucose in skeletal muscles and adipose tissue, leading to hyperglycemia. High-quality hospital care for diabetes requires standards for care delivery, which are best implemented using structured order sets and quality improvement strategies for process improvement. Unfortunately, "best practice" protocols, reviews, and guidelines are inconsistently implemented within hospitals. We will focus in this guideline on the value of established protocols in every health care facility and the benefits of implementing these protocols1.
Adult patients with diabetes account for 25% of noncritically ill hospitalized patients . Another 12% to 25% of hospitalized patients experience hyperglycemia, defined as blood glucose (BG) > 140 mg/dL 2.
Diabetes management in the inpatient setting is facilitated by identification and treatment of hyperglycemia prior to elective procedures, a dedicated inpatient diabetes management service applying validated standards of care, and a proactive transition plan for outpatient diabetes care with timely prearranged follow-up appointments. These steps can improve outcomes, shorten hospital stays, and reduce the need for readmission and emergency department visits 2.
This guidelines document is intended to provide guidance regarding inpatient hospital management of hyperglycemia for critically ill and non-critically ill patients. The guidelines cover the patient pathway within hospital including required laboratory assessment, diagnostic blood sugar cut-off values and glycemic goals recommended for critically ill and non-critical ill inpatients. The guidelines provide clear recommendations for insulin and non-insulin therapies and measures to prevent and monitor hypoglycemia.
As up to 20% of individuals undergoing general surgery have diabetes, and 23–60% have prediabetes or undiagnosed diabetes, the guidelines provide a suggested approach for perioperative management for these patients regarding pharmacological therapy dose adjustment and monitoring 2. Finally Discharge procedure and transition of patients to outpatient clinic care is detailed within this guidance