American Diabetes Association 2019 Guidelines for Diabetes Care in the Hospital
The American Diabetes Association has released its 2019 Guidelines for Diabetes Care in the Hospital in order to update care standards for inpatient management of diabetes. The American Diabetes Association (ADA) has been annually updating its Evidence-graded recommendations; this guideline provides standards of care for hospitalized patients with diabetes or hyperglycemia.
In the hospital, both high blood sugar or hyperglycemia and low blood sugar or hypoglycemia are associated with adverse outcomes, including death. Therefore, inpatient goals should include the prevention of both hyperglycemia and hypoglycemia. Hospitals should promote the shortest safe hospital stay and provide an effective transition out of the hospital that prevents acute complications and readmission.
Key Recommendations are-
- Perform an A1C on all patients with diabetes or hyperglycemia (blood glucose >140 mg/dL [7.8 mmol/L]) admitted to the hospital if not performed in the prior 3 months.
- Insulin should be administered using validated written or computerized protocols that allow for predefined adjustments in the insulin dosage based on glycemic fluctuations.
- When caring for hospitalized patients with diabetes, consider consulting with specialized diabetes or glucose management team where possible.
- Initiate insulin therapy for American Diabetes Association releases 2019 Guidelines for Diabetes Care in the Hospital (BG) levels ≥180 mg/dL in most hospitalized patients, with target Blood sugar range of 140–180 mg/dL. (Evidence grade: A)
- More stringent goals, such as 110–140 mg/dL (6.1–7.8 mmol/L), may be appropriate for selected patients if this can be achieved without significant hypoglycemia.
- Basal insulin or a basal plus bolus correction insulin regimen is the preferred treatment for noncritically ill hospitalized patients with poor oral intake or those who are taking nothing by mouth. An insulin regimen with basal, prandial, and correction components is the preferred treatment for noncritically ill hospitalized patients with good nutritional intake.
- The sole use of sliding scale insulin in the inpatient hospital setting is strongly discouraged.
- Hypoglycemia or low blood sugar 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.
- The treatment regimen should be reviewed and changed as necessary to prevent further hypoglycemia when a blood glucose value of <70 mg/dL (3.9 mmol/L) is documented.
- Recommended insulin regimens for hospitalized patients with diabetes or hyperglycemia:
–– Inpatients with adequate nutritional intake: basal + prandial + correction insulin. (Evidence grade: A)
–– Inpatients with poor nutritional intake or taking nothing by mouth: basal + correction insulin. (Evidence grade: A)
–– Sliding-scale insulin alone is strongly discouraged. (Evidence grade: A)
–– When hypoglycemia (BG <70 mg/dL) occurs, insulin therapies should be reviewed and adjusted
(Evidence grade: C)
- Implement a systematic, individualized management plan — including structured communication to the patient and primary care clinician along with medication reconciliation — at hospital discharge. (Evidence grade: B)
For further reference log on to :
American Diabetes Association. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes — 2019. Diabetes Care 2019 Jan; 42: S173. (https://doi.org/10.2337/dc19-S015)