Diabetes Care in the Hospital Setting: Difference between revisions
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{{ADA guidelines}} | {{ADA guidelines}} | ||
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[[Clinical practice guideline]]s are available<ref name="pmid29222385">{{cite journal| author=American Diabetes Association| title=14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes-2018. | journal=Diabetes Care | year= 2018 | volume= 41 | issue= Suppl 1 | pages= S144-S151 | pmid=29222385 | doi=10.2337/dc18-S014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29222385 }} </ref><ref name="pmid22223765">{{cite journal| author=Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM et al.| title=Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. | journal=J Clin Endocrinol Metab | year= 2012 | volume= 97 | issue= 1 | pages= 16-38 | pmid=22223765 | doi=10.1210/jc.2011-2098 | pmc= | url=http://care.diabetesjournals.org/content/41/Supplement_1/S144.long }} </ref>. | |||
More recent studies include: | |||
* Basal-bolus versus a basal plus correction insulin<ref name="pmid23435159">{{cite journal| author=Umpierrez GE, Smiley D, Hermayer K, Khan A, Olson DE, Newton C et al.| title=Randomized study comparing a Basal-bolus with a basal plus correction insulin regimen for the hospital management of medical and surgical patients with type 2 diabetes: basal plus trial. | journal=Diabetes Care | year= 2013 | volume= 36 | issue= 8 | pages= 2169-74 | pmid=23435159 | doi=10.2337/dc12-1988 | pmc=3714500 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23435159 }} </ref> | |||
* Basal-bolus versus sliding scale insulin<ref name="pmid25181406">{{cite journal| author=Zaman Huri H, Permalu V, Vethakkan SR| title=Sliding-scale versus basal-bolus insulin in the management of severe or acute hyperglycemia in type 2 diabetes patients: a retrospective study. | journal=PLoS One | year= 2014 | volume= 9 | issue= 9 | pages= e106505 | pmid=25181406 | doi=10.1371/journal.pone.0106505 | pmc=4152280 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25181406 }} </ref> | |||
* Basal-bolus insulin versus sliding scale insulin using the Glucommander eGlycemic Management System<ref name="pmid29222385">{{cite journal| author=American Diabetes Association| title=14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes-2018. | journal=Diabetes Care | year= 2018 | volume= 41 | issue= Suppl 1 | pages= S144-S151 | pmid=29222385 | doi=10.2337/dc18-S014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29222385 }} </ref><ref name="pmid22223765">{{cite journal| author=Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM et al.| title=Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. | journal=J Clin Endocrinol Metab | year= 2012 | volume= 97 | issue= 1 | pages= 16-38 | pmid=22223765 | doi=10.1210/jc.2011-2098 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22223765 }} </ref> | |||
==2016 ADA Standards of Medical Care in Diabetes Guidelines<ref name="pmid26696689">{{cite journal| author=American Diabetes Association| title=13. Diabetes Care in the Hospital. | journal=Diabetes Care | year= 2016 | volume= 39 Suppl 1 | issue= | pages= S99-104 | pmid=26696689 | doi=10.2337/dc16-S016 | pmc= | url=<ref name="pmid26696689">{{cite journal| author=American Diabetes Association| title=13. Diabetes Care in the Hospital. | journal=Diabetes Care | year= 2016 | volume= 39 Suppl 1 | issue= | pages= S99-104 | pmid=26696689 | doi=10.2337/dc16-S016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26696689 }} </ref>== | |||
{|class="wikitable" | {|class="wikitable" | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Consider performing an A1C on all patients with diabetes or hyperglycemia admitted to the hospital if not performed in the prior 3 months. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Consider performing an A1C on all patients with diabetes or hyperglycemia admitted to the hospital if not performed in the prior 3 months. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''9.''' There should be a structured discharge plan tailored to the individual patient. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''9.''' There should be a structured discharge plan tailored to the individual patient. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
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==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Endocrinology]] | |||
[[Category:Hospital medicine]] | |||
{{WH}}{{WS}} | {{WH}}{{WS}} | ||
Revision as of 04:14, 6 August 2018
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2016 ADA Guideline Recommendations |
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Types of Diabetes Mellitus |
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2016 ADA Standard of Medical Care Guideline Recommendations |
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Cardiovascular Disease and Risk Management |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Tarek Nafee, M.D. [3]
Clinical practice guidelines are available[1][2].
More recent studies include:
- Basal-bolus versus a basal plus correction insulin[3]
- Basal-bolus versus sliding scale insulin[4]
- Basal-bolus insulin versus sliding scale insulin using the Glucommander eGlycemic Management System[1][2]
2016 ADA Standards of Medical Care in Diabetes Guidelines
| "1. Consider performing an A1C on all patients with diabetes or hyperglycemia admitted to the hospital if not performed in the prior 3 months. (Level of Evidence: C)" |
| "2. Insulin therapy should be initiated for treatment of persistent hyperglycemia starting at a threshold ≥180 mg/dL (10.0 mmol/L). Once insulin therapy is started, a target glucose range of 140–180 mg/dL (7.8–10.0 mmol/L) is recommended for the majority of critically ill patients(Level of Evidence: A)and noncritically ill patients (Level of Evidence: C)" |
| "3. More stringent goals, such as 110–140 mg/dL (6.1–7.8 mmol/L) may be ap- propriate for selected critically ill patients, as long as this can be achieved without significant hypoglycemia (Level of Evidence: C)" |
| "4. Intravenous insulin infusions should be administered using validated written or computerized protocols that allow for predefined adjustments in the insulin infusion rate based on glycemic fluctuations and insulin dose. (Level of Evidence: E)" |
| "5. A basal plus bolus correction insulin regimen is the preferred treatment for noncritically ill patients with poor oral intake or those who are taking nothing by mouth. An insulin regimen with basal, nutritional, and correction components is the preferred treatment for patients with good nutritional intake. (Level of Evidence: A)" |
| "6. The sole use of sliding scale insulin in the inpatient hospital setting is strongly discouraged (Level of Evidence: A)" |
| "7. A hypoglycemia management protocol should be adopted and implemented by each hospital or hospital system. A plan for preventing and treating hypoglycemia should be established for each patient. Episodes of hypoglycemia in the hospital should be documented in the medical record and tracked. (Level of Evidence: E)" |
| "8. The treatment regimen should be reviewed and changed if necessary to prevent further hypoglycemia when a blood glucose value is <70 mg/dL (3.9 mmol/L). (Level of Evidence: C)" |
| "9. There should be a structured discharge plan tailored to the individual patient. (Level of Evidence: B)" |
References
- ↑ 1.0 1.1 American Diabetes Association (2018). "14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes-2018". Diabetes Care. 41 (Suppl 1): S144–S151. doi:10.2337/dc18-S014. PMID 29222385.
- ↑ 2.0 2.1 Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM; et al. (2012). "Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline". J Clin Endocrinol Metab. 97 (1): 16–38. doi:10.1210/jc.2011-2098. PMID 22223765.
- ↑ Umpierrez GE, Smiley D, Hermayer K, Khan A, Olson DE, Newton C; et al. (2013). "Randomized study comparing a Basal-bolus with a basal plus correction insulin regimen for the hospital management of medical and surgical patients with type 2 diabetes: basal plus trial". Diabetes Care. 36 (8): 2169–74. doi:10.2337/dc12-1988. PMC 3714500. PMID 23435159.
- ↑ Zaman Huri H, Permalu V, Vethakkan SR (2014). "Sliding-scale versus basal-bolus insulin in the management of severe or acute hyperglycemia in type 2 diabetes patients: a retrospective study". PLoS One. 9 (9): e106505. doi:10.1371/journal.pone.0106505. PMC 4152280. PMID 25181406.