The Endocrine Society releases new guidelines for the management of hyperglycemia in noncritical environments

The Endocrine Society has released new guidelines for the management of hyperglycemia in adult patients hospitalized in non-critical care settings.

Released June 12 at the Endocrine Society’s 2022 annual meeting with the goal of replacing the Endocrine Society’s 2012 guidelines on hospitalized patient hyperglycemia, the new guideline was co-sponsored by several organizations, including the American Association of Clinical Endocrinologists, the American Diabetes Association, the Association of Diabetes Care and Education Specialists, the Diabetes Technology Society and the European Society of Endocrinology.

“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 the chair of the guidelines’ writing committee. Mary Korytkowski, MD, professor of medicine and director of quality improvement in the Division of Endocrinology at the University of Pittsburgh, in an Endocrine Society statement.

Together with colleagues from institutions in the United States, Canada, and Europe, Korytkowski and the multidisciplinary editorial board created the new guideline with the goal of providing clinicians with evidence-based recommendations as an update. management of hyperglycemia in hospitalized patients in 2012. Critical Care Settings: An Endocrine Society Clinical Practice Guideline and to highlight emerging areas of research related to hyperglycemia in adult patients in non-healthcare settings. reviews. At 28 pages in length and citing more than 130 reference documents, the guideline recommendations are supported by a systematic review conducted by and based on a set of clinical questions formulated by the editorial board.

Published simultaneously with the guideline in the Journal of Clinical Endocrinology and Metabolism, the systematic review has 9 pages and was guided by the 10 questions formulated by the editorial board. Investigators’ initial search returned 7,482 citations. In this group, the investigators identified 94 studies involving 135,553 patients for inclusion. These studies had to answer at least 1 of 10 questions described by a guideline panel regarding the management of hyperglycaemia in non-critical care settings.

In total, the guideline provides 15 different recommendations or sub-recommendations. In their aforementioned press releases, the Endocrine Society drew attention to a group of 9 new additions to the guidelines. These highlighted additions were:

  • CGM systems can guide effective glycemic management that reduces the risk of hypoglycemia.
  • Patients receiving corticosteroid therapy or enteral nutrition are at high risk of hyperglycemia and require scheduled insulin therapy in hospital.
  • Patients using insulin pump therapy prior to 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 patients may promote better glycemic control after discharge with a reduced risk of readmission.
  • Diabetic patients undergoing elective surgery may have better outcomes when preoperative HbA1c is at or below 8% and when blood glucose in the immediate preoperative period is below 180 mg/dL.
  • It is not recommended to provide beverages containing carbohydrates preoperatively to patients with known diabetes.
  • Patients with newly recognized hyperglycemia or well-managed diabetes on non-insulin 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 ​​above 180 mg/dL and is recommended for patients using insulin therapy prior to admission.
  • DPP-4i can be used in combination with correction insulin in T2D with milder degrees of hyperglycemia and without contraindication.

This guideline, “Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline,” was published in the Journal of Clinical Endocrinology and Metabolism.