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The Endocrine Society: Test blood glucose levels upon noncritical hospitalization

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The Endocrine Society has issued clinical practice guidelines on the management of hyperglycemia in patients hospitalized in a noncritical care setting.

According to its recommendations, all patients — independent of a prior diagnosis of diabetes — should have their blood glucose levels tested upon hospital admission.

“Hyperglycemia is associated with prolonged hospital stay, increased incidence of infections and death in noncritically ill hospitalized patients,” Guillermo Umpierrez, MD, of Emory University in Atlanta, and chair of the task force that wrote the guidelines, said in a press release. “This new guideline contains consensus recommendations from experts in the field for the management of hyperglycemia in hospitalized patients in noncritical care settings.”

Recommendations from the Society include:

• Glycemic targets should be as follows: premeal glucose target of less than 140 mg/dL and a random blood glucose of less than 180 mg/dL for most hospitalized patients with a noncritical illness.
• All patients with diabetes who are treated with insulin at home should be treated with a scheduled subcutaneous insulin regimen in the hospital.
• All patients with type 1 diabetes and most with type 2 diabetes who undergo surgical procedures should receive either IV continuous insulin infusion or subcutaneous basal insulin, with bolus insulin as required, to prevent hyperglycemia during the perioperative period.
• All patients with high glucose values at admission, and in those with or without a history of diabetes receiving nutrition via IV or a feeding tube, should undergo bedside point-of-care glucose testing.
• All patients with type 1 and type 2 diabetes should be transitioned to scheduled subcutaneous therapy at least 1 to 2 hours before discontinuing IV continuous insulin infusion.

A companion patient guide to the guidelines has been made available by the Hormone Foundation, the patient education affiliate of The Endocrine Society. The guide explains the causes and effects of hyperglycemia and discusses treatment options.

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