Endocrine Society Clinical Practice Guideline

ATLANTE—According to a clinical practice guideline published today by the Endocrine Society at ENDO 2022.

The directive, entitled “Management of Hyperglycemia in Patients Hospitalized in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline”, was published online and will appear in the August 2022 print issue ofThe Journal of Clinical Endocrinology and Metabolism(JCEM), a publication of the Endocrine Society.

This guideline replaces the Society’s 2012 inpatient hyperglycemia guideline and addresses emerging areas specific to non-critically ill hospitalized patients with diabetes or newly recognized or stress-induced hyperglycemia. Hyperglycemia is the technical term for hyperglycemia. Hyperglycemia occurs when the body has too little insulin or when the body cannot use insulin properly.

This guideline addresses and updates some of the standards of care for glycemic management for non-severely hospitalized adult patients with diabetes using updated methodology that adheres to the standards of the Institute of Medicine (IOM). Updates to the 2012 guideline include consideration of blood glucose monitoring using continuous glucose monitoring devices in combination with point-of-care blood glucose measurements for patients with high risk of hypoglycemia, and providing diabetes education to hospitalized patients as part of comprehensive diabetes discharge planning. treat. Additionally, new topics include recommendations for hospital use of insulin pump therapy, management of hyperglycemia in patients receiving glucocorticoids or enteral nutrition, use of non- insulin levels, preoperative glycemic targets for patients undergoing elective surgery and specific recommendations for scheduled insulin therapy.

“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 Mary Korytkowski, MD, of the University of Pittsburgh in Pittsburgh, Pennsylvania. Korytkowski is the chairman of the committee that drafted the directive.

Key points of the guideline include:

  • Continuous glucose monitoring systems can guide effective blood glucose management that reduces the risk of hypoglycemia in hospitalized patients.
  • Patients receiving corticosteroid therapy or enteral nutrition (liquid nutrition administered directly into the digestive system) are at high risk of hyperglycemia and require scheduled insulin therapy in the hospital.
  • Patients using insulin pump therapy prior to hospital 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 hospitalized patients may promote better glycemic control after discharge with a reduced risk of hospital readmission.
  • Diabetic patients undergoing elective surgery may have better postoperative outcomes when preoperative HbA1c is ≤ 8% and when blood glucose values ​​in the immediate preoperative period are
  • 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 ​​>180 mg/dL and is recommended for patients using insulin therapy prior to admission.
  • Dipeptidyl peptidase inhibitors may be used in combination with correction insulin in some patients with type 2 diabetes who have milder degrees of hyperglycemia, provided there are no contraindications to the use of these agents.

Other members of the Endocrine Society Editorial Board who developed this guideline include: Ranganath Muniyapa of the National Institutes of Health in Bethesda, Maryland; Kellie Antinori-Lent of UPMC Shadyside in Pittsburgh, Pennsylvania; Amy C. Donihi of the University of Pittsburgh School of Pharmacy in Pittsburgh, Pennsylvania; Andjela T. Drincic of the University of Nebraska Medical Center in Omaha, Nebraska; Irl B. Hirsch of the University of Washington Medical Center-Roosevelt in Seattle, Washington; Anton Luger of the Medical University of Vienna and Vienna General Hospital in Vienna, Austria; Marie E. McDonnell of Brigham and Women’s Hospital and Harvard Medical School in Boston, Mass.; Mr. Hassan Murad of the Mayo Clinic Evidence-Based Practice Center in Rochester, Minnesota; Craig Nielsen of the Cleveland Clinic Lerner College of Medicine in Cleveland, Ohio; Claire Pegg of the Diabetes Patient Advocacy Coalition in Lexington, KY; Robert J. Rushakoff of the University of California, San Francisco in San Francisco, California; Nancy Santesso of McMaster University in Hamilton, Ontario; and Guillermo Umpierrez of Emory University in Atlanta, Ga.

The Society has established its Clinical Practice Guidelines program to provide endocrinologists and other clinicians with evidence-based recommendations in the diagnosis, treatment and management of endocrine conditions. Each guideline is developed by a multidisciplinary group of thematic experts in the field. Guideline development committees rely on evidence-based reviews of the literature to develop guideline recommendations. The Endocrine Society does not solicit or accept corporate support for its guidelines. All clinical practice guidelines are fully supported by Society funds.

This clinical practice guideline has been co-sponsored by 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. A representative of the American College of Physicians served on the editorial board.

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Endocrinologists are at the heart of solving the most pressing health issues of our time, from diabetes and obesity to infertility, bone health and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists dedicated to hormone research and physicians who care for people with hormone-related diseases.

The Society has more than 18,000 members, including scientists, doctors, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our website at www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.

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