Advances in the management of hyperglycaemia and diabetes mellitus during hospitalization

Abstract

Diabetes mellitus, which affects over 537 million people worldwide, considerably increases the risk of emergency room visits and admissions to hospital. Inpatient hyperglycaemia in patients with or without diabetes mellitus is associated with higher rates of complications, extended hospital stays and increased mortality when compared with patients with normoglycaemia. The American Diabetes Association recommends a target range of 5.6-10.0 mmol/l (100-180 mg/dl) for levels of glucose in the blood of patients in intensive care units (ICUs), as well as in general medicine and surgery. Insulin therapy remains the cornerstone of managing inpatient hyperglycaemia, with intravenous insulin preferred in ICU and basal-bolus regimens favoured in non-ICU settings. While bedside capillary blood glucose monitoring is standard for adjusting insulin doses, continuous glucose monitoring provides a more comprehensive glycaemic assessment and enhances the prevention of hypoglycaemia in high-risk hospitalized patients. This Review outlines the latest evidence in managing diabetes mellitus and hyperglycaemia within hospitals.