Diabetes Rounds

2019 Guidelines for Diabetes Care in the Hospital


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Background

The ADA annually updates its evidence-graded recommendations; this guideline provides standards of care for hospitalized patients with diabetes or hyperglycemia.

Key Recommendations

  • Initiate insulin therapy for blood glucose (BG) levels ≥180 mg/dL in most hospitalized patients, with target BG range of 140–180 mg/dL. (Evidence grade: A)

  • Recommended insulin regimens for hospitalized patients with diabetes or hyperglycemia:

    • Inpatients with adequate nutritional intake: basal + prandial + correction insulin.(Evidence grade: A)
    • Inpatients with poor nutritional intake or taking nothing by mouth: basal + correction insulin. (Evidence grade: A)
    • Sliding-scale insulin alone is strongly discouraged. (Evidence grade: A)
    • When hypoglycemia (BG <70 mg/dL) occurs, insulin therapies should be reviewed and adjusted (Evidence grade: C)
  • Determine glycosylated hemoglobin (HbA1c) levels for all patients with diabetes or hyperglycemia (BG, >140 mg/dL) if HbA1c has not recorded during the prior 3 months. (Evidence grade: B)

  • Implement a systematic, individualized management plan — including structured communication to the patient and primary care clinician along with medication reconciliation — at hospital discharge. (Evidence grade: B)

More at http://care.diabetesjournals.org/content/42/Supplement_1/S173