Endocrine Society Releases New Guidelines for Managing Hyperglycemia in Noncritical Settings

Mary Korytkowski, MD

The Endocrine Society has released new guidance for the management of hyperglycemia in hospitalized adult patients in noncritical care settings.

Released on June 12 at the Endocrine Society’s 2022 annual meeting with the intent of replacing the Endocrine Society’s 2012 guidelines for inpatient hyperglycemia, the new guideline was cosponsored by multiple organizations, including 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.

“This guideline addresses several important aspects of care specific to inpatient management of non-critically ill patients with diabetes or newly recognized hyperglycemia that have the potential to improve clinical outcomes in the hospital as well as following discharge,” said chair of the guideline writing committee Mary Korytkowski, MD, professor of medicine and director of Quality Improvement in the Division of Endocrinology at the University of Pittsburgh, in a statement from the Endocrine Society.

Together with colleagues from institutions across the US, Canada, and Europe, Korytkowski and the multidisciplinary writing committee created the new guideline with the intent of providing clinicians with evidence-based recommendations as an update to the 2012 Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline and to highlight emerging areas of research related to hyperglycemia in adult patients noncritical care settings. At 28 pages in length and citing more than 130 reference documents, the recommendations within the guideline are backed by a systematic review performed by and based on a group of clinical questions formulated by the writing committee.

Simultaneously published alongside the guideline in the Journal of Clinical Endocrinology & Metabolism, the systematic review is 9 pages in length and was guided by the 10 questions formulated by the writing committee. The investigators’ initial search returned 7482 citations. From this group, investigators identified 94 studies reporting on 135,553 patients for inclusion. These studies were required to address at least 1 of 10 questions outlined by a guideline panel pertaining to management of hyperglycemia in noncritical care settings.

In total, the guideline provides 15 different recommendations or subrecommendations. In their aforementioned press releases, the Endocrine Society called attention to a group of 9 new additions to the guidelines. These highlighted additions were:

• CGM systems can guide effective glycemic management that reduces risk for hypoglycemia.
• Patients receiving glucocorticoid therapy or enteral nutrition are at high risk for hyperglycemia and require scheduled insulin therapy in the hospital.
• Patients using insulin pump therapy before admission may self-manage these devices if they have the mental and physical capacity to do so with oversight by hospital personnel.
• Diabetes self-management education provided to patients can promote improved glycemic control following discharge with reductions in the risk for readmission.
• Patients with diabetes scheduled for elective surgery may have improved outcomes when preoperative HbA1c is at or below 8% and when blood glucose in the immediate preoperative period are below 180 mg/dL.
• Providing pre-operative carbohydrate-containing beverages to patients with known diabetes is not recommended.
• Patients with newly recognized hyperglycemia or well-managed diabetes on non-insulin therapy may be treated with correctional insulin alone as initial therapy at hospital admission.
• Scheduled insulin therapy is preferred for patients experiencing persistent blood glucose values above 180 mg/dL and is recommended for patients using insulin therapy prior to admission.
• DPP-4i can be used in combination with correction insulin in T2D with milder degrees of hyperglycemia and no contraindication.

This guideline, “Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline,” was published in the Journal of Clinical Endocrinology & Metabolism.