Hyperglycemia, or high blood sugar (glucose) levels, is a common, serious and expensive health care problem in hospitalized patients that is linked to an increased risk of health complications and mortality. It can also affect non-diabetic 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.

In order to provide 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 non-critical care setting, The Endocrine Society has released new clinical practice guidelines (CPG), which recommends 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.

The CPG called “Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline,” will be published in the February 2012 issue of the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society.

Guillermo Umpierrez, MD, of Emory University in Atlanta, Ga. and chair of the task force that authored the CPG explained:

“Hyperglycemia is associated with prolonged hospital stay, increased incidence of infections and death in non-critically ill hospitalized patients. This new guideline contains consensus recommendations from experts in the field for the management of hyperglycemia in hospitalized patients in non-critical care settings.”

The Endocrine Society specifically recommends the following in their new CPG:

  • Most hospitalized patients with non-critical illness glycemic targets should have a pre-meal glucose target of less than 140 mg/dl and random blood glucose of less than 180 mg/dl.
  • All patients who have high glucose values on admission and those with or without a history of diabetes who receive nutrition either through IV or a feeding tube should receive bedside point-of-care glucose testing.
  • All diabetic patients receiving insulin at home should be treated with a scheduled subcutaneous insulin regimen during their hospital stay
  • All patients with type 1 diabetes and most with type 2 diabetes who undergo surgical procedures should receive either intravenous (IV) continuous insulin infusion or subcutaneous basal insulin with bolus insulin as needed in order to prevent hyperglycemia during the perioperative period.
  • All patients with type 1 and type 2 diabetes should be transitioned to scheduled subcutaneous insulin therapy at least one to two hours before discontinuation of iv continuous insulin infusion.

The Endocrine Society’s patient education affiliate, The Hormone Foundation, has published a patient guide to accompany the CPG guide, which can be found online with explanations of the causes and impacts of hyperglycemia. The patient guide also offers advice on treatment options.

The Clinical Practice Guideline (CPG) Program was established by The Endocrine Society. 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 Endocrine Society does not solicit or accept corporate support for its CPGs as all CPGs are entirely supported by Society funds.

Members of The Endocrine Society consortium who developed this CPG include: Richard Hellman and Mikhail Kosiborod of the University of Missouri-Kansas City; Mary Korytkowski of the University of Pittsburgh in Penn.; Gregory Maynard of the University of California San Diego Medical Center; Victor Montori of the Mayo Clinic in Rochester, Minn.; Jane Seley of New York Presbyterian Hospital in N.Y.; and Greet Van den Berghe of the Catholic University of Leuven in Belgium.

Written by Petra Rattue