Diabetes Care in the Hospital Setting: Difference between revisions
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*[[Basal (medicine)|Basal-bolus]] versus [[Basal (medicine)|basal]] Plus sliding scale versus sliding scale alone<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 (medicine)|Basal-bolus]] versus [[Basal (medicine)|basal]] Plus sliding scale versus sliding scale alone<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>. | ||
*[[Insulin]] [[Analog (chemistry)|analogues]] versus human [[insulin]].<ref name="pmid26121460">{{cite journal| author=Bueno E, Benitez A, Rufinelli JV, Figueredo R, Alsina S, Ojeda A et al.| title=BASAL-BOLUS REGIMEN WITH INSULIN ANALOGUES VERSUS HUMAN INSULIN IN MEDICAL PATIENTS WITH TYPE 2 DIABETES: A RANDOMIZED CONTROLLED TRIAL IN LATIN AMERICA. | journal=Endocr Pract | year= 2015 | volume= 21 | issue= 7 | pages= 807-13 | pmid=26121460 | doi=10.4158/EP15675.OR | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26121460 }} </ref> | *[[Insulin]] [[Analog (chemistry)|analogues]] versus human [[insulin]].<ref name="pmid26121460">{{cite journal| author=Bueno E, Benitez A, Rufinelli JV, Figueredo R, Alsina S, Ojeda A et al.| title=BASAL-BOLUS REGIMEN WITH INSULIN ANALOGUES VERSUS HUMAN INSULIN IN MEDICAL PATIENTS WITH TYPE 2 DIABETES: A RANDOMIZED CONTROLLED TRIAL IN LATIN AMERICA. | journal=Endocr Pract | year= 2015 | volume= 21 | issue= 7 | pages= 807-13 | pmid=26121460 | doi=10.4158/EP15675.OR | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26121460 }} </ref> | ||
* Basal-bolus insulin versus sliding scale insulin using the Glucommander | *[[Basal (medicine)|Basal-bolus]] [[insulin]] versus sliding scale [[insulin]] using the Glucommander eGlycemic Management System.<ref name="pmid 29237289">{{cite journal| author=Newsom R, Patty C, Camarena E, Sawyer R, McFarland R, Gray T et al.| title=Safely Converting an Entire Academic Medical Center From Sliding Scale to Basal Bolus Insulin via Implementation of the eGlycemic Management System. | journal=J Diabetes Sci Technol | year= 2018 | volume= 12 | issue= 1 | pages= 53-59 | pmid= 29237289 | doi=10.1177/1932296817747619 | pmc=5761993 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29237289 }} </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>== | ==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 [[Glycosylated hemoglobin|A1C]] on all [[patient|patients]] with [[diabetes]] or [[hyperglycemia]] admitted to the hospital if not performed in the previous 3 months. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Consider performing an [[Glycosylated hemoglobin|A1C]] on all [[patient|patients]] with [[diabetes]] or [[hyperglycemia]] admitted to the hospital if not performed in the previous 3 months. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' [[Intravenous therapy|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. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' [[Intravenous therapy|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. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''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. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''5.''' A [[Basal (medicine)|basal]] plus bolus correction [[insulin]] regimen is the preferred [[treatment]] for noncritically ill [[patients]] with poor [[Mouth|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. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''6.''' The sole use of sliding scale insulin in the inpatient hospital setting is strongly discouraged ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''6.''' The sole use of sliding scale [[insulin]] in the inpatient hospital setting is strongly discouraged ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''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. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''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. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''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). ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''8.''' The [[treatment]] regimen should be reviewed and changed if necessary to prevent further [[hypoglycemia]] when a [[b;ood sugar|blood glucose]] value is <70 mg/dL (3.9 mmol/L). ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<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> | | 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> | ||
|- | |- | ||
|} | |} | ||
*Formerly guidelines advocated to stop all [[mouth|oral]] [[Anti-diabetic drug|antidiabetic agents]] in the hospital settings of [[diabetes]] management, nevertheless some [[clinical trials]] support the effectiveness of [[mouth|oral]] [[Anti-diabetic drug|antidiabetic drugs]], solitary or in combination to [[insulin]] [[therapy]], in some hospitalized individuals.<ref name="pmid33515493">{{cite journal| author=Pasquel FJ, Lansang MC, Dhatariya K, Umpierrez GE| title=Management of diabetes and hyperglycaemia in the hospital. | journal=Lancet Diabetes Endocrinol | year= 2021 | volume= 9 | issue= 3 | pages= 174-188 | pmid=33515493 | doi=10.1016/S2213-8587(20)30381-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33515493 }} </ref> | |||
==References== | ==References== | ||
Revision as of 18:33, 22 April 2021
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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]
There are some available clinical practice guidelines and systematic reviews that suggest basal-bolus insulin may lower blood sugar more efficient, nevertheless it is more likely to cause hypoglycemia[1] with no change in clinical outcomes[2].[3][4].
Key studies include:
- Basal-bolus versus a basal plus correction insulin[5]
- Basal-bolus versus sliding scale insulin[6]
- Basal-bolus versus basal Plus sliding scale versus sliding scale alone[5].
- Insulin analogues versus human insulin.[7]
- Basal-bolus insulin versus sliding scale insulin using the Glucommander eGlycemic Management System.[8]
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 previous 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)" |
- Formerly guidelines advocated to stop all oral antidiabetic agents in the hospital settings of diabetes management, nevertheless some clinical trials support the effectiveness of oral antidiabetic drugs, solitary or in combination to insulin therapy, in some hospitalized individuals.[9]
References
- ↑ Christensen MB, Gotfredsen A, Nørgaard K (2017). "Efficacy of basal-bolus insulin regimens in the inpatient management of non-critically ill patients with type 2 diabetes: A systematic review and meta-analysis". Diabetes Metab Res Rev. 33 (5). doi:10.1002/dmrr.2885. PMID 28067472.
- ↑ Gómez Cuervo C, Sánchez Morla A, Pérez-Jacoiste Asín MA, Bisbal Pardo O, Pérez Ordoño L, Vila Santos J (2016). "Effective adverse event reduction with bolus-basal versus sliding scale insulin therapy in patients with diabetes during conventional hospitalization: Systematic review and meta-analysis". Endocrinol Nutr. 63 (4): 145–56. doi:10.1016/j.endonu.2015.11.008. PMID 26826772.
- ↑ 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.
- ↑ 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.
- ↑ 5.0 5.1 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.
- ↑ Bueno E, Benitez A, Rufinelli JV, Figueredo R, Alsina S, Ojeda A; et al. (2015). "BASAL-BOLUS REGIMEN WITH INSULIN ANALOGUES VERSUS HUMAN INSULIN IN MEDICAL PATIENTS WITH TYPE 2 DIABETES: A RANDOMIZED CONTROLLED TRIAL IN LATIN AMERICA". Endocr Pract. 21 (7): 807–13. doi:10.4158/EP15675.OR. PMID 26121460.
- ↑ Newsom R, Patty C, Camarena E, Sawyer R, McFarland R, Gray T; et al. (2018). "Safely Converting an Entire Academic Medical Center From Sliding Scale to Basal Bolus Insulin via Implementation of the eGlycemic Management System". J Diabetes Sci Technol. 12 (1): 53–59. doi:10.1177/1932296817747619. PMC 5761993. PMID 29237289.
- ↑ Pasquel FJ, Lansang MC, Dhatariya K, Umpierrez GE (2021). "Management of diabetes and hyperglycaemia in the hospital". Lancet Diabetes Endocrinol. 9 (3): 174–188. doi:10.1016/S2213-8587(20)30381-8. PMID 33515493 Check
|pmid=value (help).