Rapid Clinical Updates: Inpatient Management of Diabetes-Handout

Handout

Pdf Summary

The document summarizes key inpatient diabetes management principles:

- <strong>Inpatient glucose goals:</strong> Hospitalized patients have changing medications, nutrition, and physiologic stress that can worsen glucose control. Inpatient hyperglycemia is associated with higher mortality. The recommended target glucose range is <strong>140–180 mg/dL</strong>. If there are <strong>two glucose readings above 180 within 24 hours</strong>, diabetes treatment should be adjusted.

- <strong>Oral diabetes medications:</strong> Oral antihyperglycemic drugs have traditionally been held during hospitalization. <strong>Basal-bolus insulin</strong> remains the preferred initial inpatient strategy, while <strong>sliding-scale insulin alone is usually ineffective</strong>. Non-insulin therapies may be restarted before discharge once the patient is stable. <strong>Sulfonylureas and SGLT-2 inhibitors</strong> are generally best held throughout admission. <strong>Metformin, pioglitazone, and possibly DPP-4 inhibitors</strong> may sometimes be safely continued.

- <strong>Steroid-induced hyperglycemia:</strong> Steroids cause predictable blood glucose rises and falls. Insulin can be matched to the steroid used: <strong>hydrocortisone</strong> may pair well with <strong>regular insulin or NPH</strong>, while <strong>prednisone and methylprednisolone</strong> often align with <strong>NPH or detemir</strong>. An <strong>A1C on admission</strong> can help plan discharge therapy: <strong>A1C 7–10</strong> suggests outpatient medication adjustment, and <strong>A1C >10</strong> suggests adding outpatient insulin.

- <strong>Expanding medication roles:</strong> Diabetes drugs are increasingly used for <strong>cardiovascular and kidney disease</strong>, not just diabetes. <strong>SGLT-2 inhibitors</strong> have benefits for <strong>CAD, heart failure, and stroke/TIA</strong>, while <strong>GLP-1 receptor agonists</strong> benefit <strong>CAD, stroke/TIA, and CKD</strong>. Hospitalists are increasingly expected to start these medications before discharge and participate in long-term disease management.

Keywords

inpatient diabetes management

glucose target 140-180

hyperglycemia mortality

basal-bolus insulin

sliding-scale insulin

steroid-induced hyperglycemia

metformin

SGLT-2 inhibitors

GLP-1 receptor agonists

A1C discharge planning