Diabetes Care in the Hospital Setting
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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].
Systematic reviews are available. The reviews suggest basal-bolus may better lower sugar, but is more likely to cause hypoglycemic[3] with no change in clinical outcomes[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 only[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 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
- ↑ 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.
- ↑ 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.
- ↑ 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.