Management of diabetes and hyperglycaemia in the hospital

• Authors: Francisco Pasquel, Emory University; M. Cecilia Lansang, Cleveland Clinic; Ketan Dhatariya, Norfolk & Norwich University Hospital; Guillermo Umpierrez, Emory University
• Journal Title: LANCET DIABETES & ENDOCRINOLOGY
• Volume: Volume 9, Number 3
• Publisher: ELSEVIER SCIENCE INC | 2021-02-16, Pages 174-188
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/S2213-8587(20)30381-8
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Endocrinology & Metabolism; RANDOMIZED CONTROLLED-TRIAL; BASAL-BOLUS INSULIN; PERIOPERATIVE GLYCEMIC CONTROL; GLUCAGON-LIKE PEPTIDE-1; INCRETIN-BASED THERAPY; BLOOD-GLUCOSE CONTROL; INPATIENT MANAGEMENT; SURGERY PATIENTS; INTRAVENOUS EXENATIDE; STANDARD TREATMENT

Abstract

Hyperglycaemia in people with and without diabetes admitted to the hospital is associated with a substantial increase in morbidity, mortality, and health-care costs. Professional societies have recommended insulin therapy as the cornerstone of inpatient pharmacological management. Intravenous insulin therapy is the treatment of choice in the critical care setting. In non-intensive care settings, several insulin protocols have been proposed to manage patients with hyperglycaemia; however, meta-analyses comparing different treatment regimens have not clearly endorsed the benefits of any particular strategy. Clinical guidelines recommend stopping oral antidiabetes drugs during hospitalisation; however, in some countries continuation of oral antidiabetes drugs is commonplace in some patients with type 2 diabetes admitted to hospital, and findings from clinical trials have suggested that non-insulin drugs, alone or in combination with basal insulin, can be used to achieve appropriate glycaemic control in selected populations. Advances in diabetes technology are revolutionising day-to-day diabetes care and work is ongoing to implement these technologies (ie, continuous glucose monitoring, automated insulin delivery) for inpatient care. Additionally, transformations in care have occurred during the COVID-19 pandemic, including the use of remote inpatient diabetes management—research is needed to assess the effects of such adaptations.