Table of contents
In-hospital hyperglycemia
What's new
Updated 2024 SCCM guidelines on glycemic control in critically ill patients.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of in-hospital hyperglycemia are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024), the American Diabetes Association (ADA 2024), the Society of Critical Care Medicine (SCCM 2024), the Endocrine Society (ES 2022), the Society for Cardiovascular Angiography and Interventions (SCAI/AHA/ACC 2022), the European ...
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Diagnostic investigations
Medical management
General principles
As per ADA 2024 guidelines:
Consult with a specialized diabetes or glucose management team when accessible when caring for hospitalized patients with diabetes (with an existing or new diagnosis) or stress hyperglycemia.
B
Tailor structured discharge plans to individual patients with diabetes.
B
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Treatment targets
Insulin therapy
Non-insulin therapy
Inpatient care
Prevention of hypoglycemia
As per ADA 2024 guidelines:
Review treatment plans and change as necessary to prevent hypoglycemia and recurrent hypoglycemia when a blood glucose value of < 70 mg/dL (> 3.9 mmol/L) is documented.
B
Adopt a hypoglycemia management protocol and implement it in each hospital or hospital system. Establish a plan for the prevention and treatment of hypoglycemia for each patient. Document episodes of hypoglycemia in the hospital in the electronic record and track for quality assessment and improvement.
E
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Glucose monitoring
Perioperative care
Specific circumstances
Pediatric patients: as per SCCM 2024 guidelines, initiate glycemic management protocols and procedures to treat persistent hyperglycemia ≥ 10 mmol/L (180 mg/dL) in critically ill pediatric patients.
E
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Patients with myocardial infarction
Patients with AIS
Patient education
Quality improvement
Institutional protocols: as per ADA 2024 guidelines, ensure that institutions implement protocols using validated written or computerized provider order entry sets for the management of dysglycemia in the hospital (including emergency department, ICU and non-ICU wards, gynecology-obstetrics/delivery units, dialysis suites, and behavioral health units) allowing for a personalized approach, including glucose monitoring, insulin and/or noninsulin therapy, hypoglycemia management, diabetes self-management education, nutrition recommendations, and transitions of care.
B