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In-hospital hyperglycemia

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 Diabetes Association (ADA 2024), the Society of Critical Care Medicine (SCCM 2024), the American Academy of Family Physicians (AAFP 2024), the Endocrine Society (ES 2022), the Society for Cardiovascular Angiography and Interventions (SCAI/AHA/ACC 2022), the European Society of Cardiology (ESC 2021; 2018), and the American Heart Association (AHA/ASA 2019).
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Guidelines

1.Diagnostic investigations

Hemoglobin A1C testing: obtain HbA1c testing in all patients with diabetes or hyperglycemia (random blood glucose > 140 mg/dL; > 7.8 mmol/L) admitted to the hospital if no HbA1c test is available from the prior 3 months.
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2.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.
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Tailor structured discharge plans to individual patients with diabetes.
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More topics in this section

  • Treatment targets

  • Insulin therapy

  • Non-insulin therapy

3.Inpatient care

Prevention of hypoglycemia
Review treatment plans and change as necessary to prevent hypoglycemia and recurrent recurrent when a blood glucose value of < 70 mg/dL (> 3.9 mmol/L) is documented.
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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.
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More topics in this section

  • Glucose monitoring

4.Perioperative care

Oral carbohydrate fluids: avoid administering preoperative carbohydrate-containing oral fluids in adult patients with T1DM, T2DM, or other forms of diabetes undergoing surgical procedures.
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5.Specific circumstances

Pediatric patients: initiate glycemic management protocols and procedures to treat persistent hyperglycemia ≥ 10 mmol/L (180 mg/dL) in critically ill pediatric patients.
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  • Patients with myocardial infarction

  • Patients with AIS

6.Patient education

Patient education: consider providing inpatient diabetes education as part of a comprehensive diabetes discharge-planning process in adult patients with diabetes hospitalized for a non-critical illness.
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7.Quality improvement

Institutional protocols: 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.
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