Management of Diabetes and Hyperglycemia in the Hospital: A Systematic Review of Clinical Practice Guidelines
Abstract
BACKGROUND
Inpatient hyperglycemia is common among adults, and management varies.
PURPOSE
To systematically identify guidelines on inpatient hyperglycemia management.
DATA SOURCES
MEDLINE, Guidelines International Network, and specialty society websites were searched from 1 January 2010 to 14 August 2024.
STUDY SELECTION
Clinical practice guidelines pertaining to blood glucose management in hospitalized adults were included.
DATA EXTRACTION
Two authors screened articles and extracted data, and three assessed guideline quality. Recommendations on inpatient monitoring, treatment targets, medications, and care transitions were collected.
DATA SYNTHESIS
Guidelines from 10 organizations met inclusion criteria, and 5 were assessed to be of high quality per the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument. All guidelines recommended monitoring blood glucose for patients with diabetes and nine for admission hyperglycemia. Eight guidelines recommended an upper blood glucose target of 180 mg/dL, five with a lower limit of 100 mg/dL and three of 140 mg/dL. Guidelines were in agreement on using capillary blood glucose monitoring, and three guidelines included discussion of continuous monitoring. Hyperglycemia treatment with basal-bolus insulin alone (n = 3) or with correction (n = 5) was most commonly recommended, while sliding scale insulin was advised against (n = 5). Guidance on use of oral diabetes medications was inconsistent. Five guidelines included…
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Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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