It is recommended that all patients should have their blood glucose levels tested on admission to a hospital, irrespective of whether they have been diagnosed with diabetes or not.
Professional endocrinologists has released new clinical practice guidelines recommendations for practical and safe glycemic targets as well as offering protocols and system improvements needed to achieve glycemic goals for hospitalized patients in a noncritical care setting.
A team of experts, led by those at Emory University School of Medicine (Atlanta, GA, USA) have published a new guideline which contains consensus recommendations from experts in the field for the management of diabetes in hospitalized patients. Hyperglycemia, or high blood sugar (glucose) levels, is a common, serious and expensive healthcare problem in hospitalized patients that is linked to an increased risk of complications and mortality. It can also affect nondiabetic hospitalized patients. According to observational studies, 32% to 38% of patients in community hospitals suffer from hyperglycemia. Improving glycemic control leads to lower hospital complications in general medicine and surgery patients.
The recommendations include that most hospitalized patients with noncritical illness glycemic targets should have a premeal glucose target of less than 140 mg/dL and random blood glucose of less than 180 mg/dL. Also that all inpatients with known diabetes or with hyperglycemia of greater than 7.8 mmol/liter (140 mg/dL) be assessed with a hemoglobin A1C (HbA1C) level if this has not been performed in the preceding 2-3 months. Additional recommendations include a premeal glucose target of less than 140 mg/dL (7.8 mmol/liter) and a random blood glucose of less than 180 mg/dL (10.0 mmol/L) for the majority of hospitalized patients with noncritical illness. They recommend implementation of a standardized hospital-wide, nurse-initiated hypoglycemia treatment protocol to prompt immediate therapy of any recognized hypoglycemia, defined as blood glucose below 3.9 mmol/L (70 mg/dL).
The Clinical Practice Guideline (CPG) Program was established by The Endocrine Society (Chevy Chase, MD, USA). It provides endocrinologists and other clinicians with evidence-based recommendations for diagnosing and treating endocrine-related conditions. A consortium of topic-related endocrine experts creates each CPG recommendation based on scientific reviews of literature. The recommendations were published in the January 2012 issue of the Journal of Clinical Endocrinology & Metabolism (JCEM).
Emory University School of Medicine
The Endocrine Society