Rapid Clinical Updates: Inpatient Management of Diabetes-Handout

Handout

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This summary outlines key principles in managing inpatient hyperglycemia and diabetes medications. Inpatients experience fluctuating glucose metabolism due to varied medications, nutrition, and physiological stress. Hyperglycemia is linked to increased inpatient mortality, with target glucose levels set between 140-180 mg/dL. If two glucose readings exceed 180 mg/dL within 24 hours, diabetes treatments should be adjusted.<br /><br />Traditionally, oral antihyperglycemic agents are withheld during hospital stays. Basal-bolus insulin remains the preferred initial regimen, as sliding scale insulin alone is generally ineffective. Certain non-insulin therapies may be safely reintroduced before discharge after patient stabilization. Sulfonylureas and SGLT-2 inhibitors are best avoided inpatient, whereas metformin, pioglitazone, and possibly DPP-4 inhibitors can be continued in select cases.<br /><br />Steroid use induces predictable blood glucose peaks and troughs. Insulin dosing can be tailored to steroid type: hydrocortisone corresponds well with regular or NPH insulin, while prednisone and methylprednisolone align with NPH or detemir insulin. Admission hemoglobin A1C assists in guiding discharge therapy—A1C between 7-10% suggests the need for outpatient medication adjustment, and A1C above 10% supports starting insulin.<br /><br />Antihyperglycemic drugs are increasingly prescribed not only for diabetes but also for cardiovascular and kidney disease. SGLT-2 inhibitors are indicated for coronary artery disease, heart failure, and stroke/TIA, while GLP-1 receptor agonists benefit CAD, stroke/TIA, and chronic kidney disease. Hospitalists are playing a larger role in initiating these therapies prior to discharge, emphasizing management of chronic metabolic conditions alongside acute inpatient care.<br /><br />References cited include clinical guidelines and studies supporting these approaches to optimize inpatient glycemic control and leverage therapeutics for broader cardiometabolic benefits.

Keywords

inpatient hyperglycemia

diabetes medications

glucose metabolism

basal-bolus insulin

oral antihyperglycemic agents

SGLT-2 inhibitors

steroid-induced hyperglycemia

hemoglobin A1C

cardiovascular disease

chronic kidney disease