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Current Standards of Care for Inpatient Type 2 Diabetes Mellitus

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Diabetes Management in Hospitalized Patients

Part of the book series: Contemporary Endocrinology ((COE))

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Abstract

Diabetes mellitus predisposes to multiple cardiovascular and infectious complications that require surgical procedures and hospital admissions. Diabetes, hyperglycemia, and hypoglycemia are each associated with increased morbidity and adverse outcomes. Effective glycemic management with structured approaches to care, from admission to discharge planning, is therefore necessary. Identifying hyperglycemia and diagnosing known or new-onset diabetes among inpatients are the fundamental first steps, followed by appropriate glucose monitoring. Proper initiation and titration of insulin, along with non-insulin therapies in select patients, form the core of inpatient pharmacologic treatment of hyperglycemia. This chapter reviews the current standards of inpatient care for the noncritically ill patient with type 2 diabetes mellitus and/or hyperglycemia.

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References

  1. Magliano DJ, Boyko EJ. IDF Diabetes Atlas. 10th ed. Brussels: International Diabetes Federation; 2021.

    Google Scholar 

  2. American Diabetes Association. Economic costs of diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917–28.

    Article  PubMed Central  Google Scholar 

  3. Choi J, Booth G, Jung HY, Lapointe-Shaw L, Tang T, Kwan JL, et al. Association of diabetes with frequency and cost of hospital admissions: a retrospective cohort study. CMAJ Open. 2021;9(2):E406–E12.

    Article  PubMed  PubMed Central  Google Scholar 

  4. National Diabetes Statistics Report 2020.

    Google Scholar 

  5. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87(3):978–82.

    Article  CAS  PubMed  Google Scholar 

  6. Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. 2000;355(9206):773–8.

    Article  CAS  PubMed  Google Scholar 

  7. Inzucchi SE. Clinical practice. Management of hyperglycemia in the hospital setting. N Engl J Med. 2006;355(18):1903–11.

    Article  CAS  PubMed  Google Scholar 

  8. Ishihara M, Kojima S, Sakamoto T, Asada Y, Tei C, Kimura K, et al. Acute hyperglycemia is associated with adverse outcome after acute myocardial infarction in the coronary intervention era. Am Heart J. 2005;150(4):814–20.

    Article  CAS  PubMed  Google Scholar 

  9. Korytkowski MT, Muniyappa R, Antinori-Lent K, Donihi AC, Drincic AT, Hirsch IB, et al. Management of hyperglycemia in hospitalized adult patients in non-critical care settings: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2022;107(8):2101–28.

    Article  PubMed  PubMed Central  Google Scholar 

  10. ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. 16. Diabetes care in the hospital: standards of care in diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S267–S78.

    Article  PubMed  Google Scholar 

  11. Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, et al. American Association of Clinical Endocrinology clinical practice guideline: developing a diabetes mellitus comprehensive care Plan-2022 update. Endocr Pract. 2022;28(10):923–1049.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Svensson AM, McGuire DK, Abrahamsson P, Dellborg M. Association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events. Eur Heart J. 2005;26(13):1255–61.

    Article  PubMed  Google Scholar 

  13. Pinto DS, Skolnick AH, Kirtane AJ, Murphy SA, Barron HV, Giugliano RP, et al. U-shaped relationship of blood glucose with adverse outcomes among patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2005;46(1):178–80.

    Article  CAS  PubMed  Google Scholar 

  14. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, Blair D, Foster D, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.

    Article  Google Scholar 

  15. Bagshaw SM, Egi M, George C, Bellomo R, Australia New Zealand Intensive Care Society Database Management Committee. Early blood glucose control and mortality in critically ill patients in Australia. Crit Care Med. 2009;37(2):463–70.

    Article  CAS  PubMed  Google Scholar 

  16. Brutsaert E, Carey M, Zonszein J. The clinical impact of inpatient hypoglycemia. J Diabetes Complicat. 2014;28(4):565–72.

    Article  Google Scholar 

  17. Pasquel FJ, Gomez-Huelgas R, Anzola I, Oyedokun F, Haw JS, Vellanki P, et al. Predictive value of admission hemoglobin A1c on inpatient glycemic control and response to insulin therapy in medicine and surgery patients with type 2 diabetes. Diabetes Care. 2015;38(12):e202–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Umpierrez GE, Reyes D, Smiley D, Hermayer K, Khan A, Olson DE, et al. Hospital discharge algorithm based on admission HbA1c for the management of patients with type 2 diabetes. Diabetes Care. 2014;37(11):2934–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Greci LS, Kailasam M, Malkani S, Katz DL, Hulinsky I, Ahmadi R, et al. Utility of HbA(1c) levels for diabetes case finding in hospitalized patients with hyperglycemia. Diabetes Care. 2003;26(4):1064–8.

    Article  PubMed  Google Scholar 

  20. Desouza CV, Holcomb RG, Rosenstock J, Frias JP, Hsia SH, Klein EJ, et al. Results of a study comparing glycated albumin to other glycemic indices. J Clin Endocrinol Metab. 2020;105(3):677.

    Article  PubMed  Google Scholar 

  21. Danese E, Montagnana M, Nouvenne A, Lippi G. Advantages and pitfalls of fructosamine and glycated albumin in the diagnosis and treatment of diabetes. J Diabetes Sci Technol. 2015;9(2):169–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Murad MH, Coburn JA, Coto-Yglesias F, Dzyubak S, Hazem A, Lane MA, et al. Glycemic control in non-critically ill hospitalized patients: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012;97(1):49–58.

    Article  CAS  PubMed  Google Scholar 

  23. Ehrhardt N, Hirsch IB. The impact of COVID-19 on CGM use in the hospital. Diabetes Care. 2020;43(11):2628–30.

    Article  CAS  PubMed  Google Scholar 

  24. Galindo RJ, Aleppo G, Klonoff DC, Spanakis EK, Agarwal S, Vellanki P, et al. Implementation of continuous glucose monitoring in the hospital: emergent considerations for remote glucose monitoring during the COVID-19 pandemic. J Diabetes Sci Technol. 2020;14(4):822–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Davis GM, Spanakis EK, Migdal AL, Singh LG, Albury B, Urrutia MA, et al. Accuracy of Dexcom G6 continuous glucose monitoring in non-critically ill hospitalized patients with diabetes. Diabetes Care. 2021;44(7):1641–6.

    Article  PubMed  PubMed Central  Google Scholar 

  26. FDA Grants Breakthrough Device Designation for Dexcom Hospital CGM System [online]. Dexcom; 2022 [webpage].

    Google Scholar 

  27. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359–67.

    Article  PubMed  Google Scholar 

  28. Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354(5):449–61.

    Article  PubMed  Google Scholar 

  29. Kansagara D, Fu R, Freeman M, Wolf F, Helfand M. Intensive insulin therapy in hospitalized patients: a systematic review. Ann Intern Med. 2011;154(4):268–82.

    Article  PubMed  Google Scholar 

  30. Khazai NB, Hamdy O. Inpatient diabetes management in the twenty-first century. Endocrinol Metab Clin N Am. 2016;45(4):875–94.

    Article  Google Scholar 

  31. Hirsch IB. Insulin analogues. N Engl J Med. 2005;352(2):174–83.

    Article  CAS  PubMed  Google Scholar 

  32. Diabetes Control and Complications Trial Research Group, Nathan DM, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.

    Article  Google Scholar 

  33. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837–53.

    Article  Google Scholar 

  34. Galindo RJ, Pasquel FJ, Vellanki P, Alicic R, Lam DW, Fayfman M, et al. Degludec hospital trial: a randomized controlled trial comparing insulin degludec U100 and glargine U100 for the inpatient management of patients with type 2 diabetes. Diabetes Obes Metab. 2022;24(1):42–9.

    Article  CAS  PubMed  Google Scholar 

  35. Pasquel FJ, Gianchandani R, Rubin DJ, Dungan KM, Anzola I, Gomez PC, et al. Efficacy of sitagliptin for the hospital management of general medicine and surgery patients with type 2 diabetes (Sita-Hospital): a multicentre, prospective, open-label, non-inferiority randomised trial. Lancet Diabetes Endocrinol. 2017;5(2):125–33.

    Article  CAS  PubMed  Google Scholar 

  36. Vellanki P, Rasouli N, Baldwin D, Alexanian S, Anzola I, Urrutia M, et al. Glycaemic efficacy and safety of linagliptin compared to a basal-bolus insulin regimen in patients with type 2 diabetes undergoing non-cardiac surgery: a multicentre randomized clinical trial. Diabetes Obes Metab. 2019;21(4):837–43.

    Article  CAS  PubMed  Google Scholar 

  37. Garg R, Schuman B, Hurwitz S, Metzger C, Bhandari S. Safety and efficacy of saxagliptin for glycemic control in non-critically ill hospitalized patients. BMJ Open Diabetes Res Care. 2017;5(1):e000394.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Fayfman M, Galindo RJ, Rubin DJ, Mize DL, Anzola I, Urrutia MA, et al. A randomized controlled trial on the safety and efficacy of exenatide therapy for the inpatient management of general medicine and surgery patients with type 2 diabetes. Diabetes Care. 2019;42(3):450–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(1):16–38.

    Article  CAS  PubMed  Google Scholar 

  40. Queale WS, Seidler AJ, Brancati FL. Glycemic control and sliding scale insulin use in medical inpatients with diabetes mellitus. Arch Intern Med. 1997;157(5):545–52.

    Article  CAS  PubMed  Google Scholar 

  41. Baldwin D, Zander J, Munoz C, Raghu P, DeLange-Hudec S, Lee H, et al. A randomized trial of two weight-based doses of insulin glargine and glulisine in hospitalized subjects with type 2 diabetes and renal insufficiency. Diabetes Care. 2012;35(10):1970–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Walsh J, Roberts R, Bailey T. Guidelines for insulin dosing in continuous subcutaneous insulin infusion using new formulas from a retrospective study of individuals with optimal glucose levels. J Diabetes Sci Technol. 2010;4(5):1174–81.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Davidson PC, Hebblewhite HR, Steed RD, Bode BW. Analysis of guidelines for basal-bolus insulin dosing: basal insulin, correction factor, and carbohydrate-to-insulin ratio. Endocr Pract. 2008;14(9):1095–101.

    Article  PubMed  Google Scholar 

  44. Umpierrez GE, Palacio A, Smiley D. Sliding scale insulin use: myth or insanity? Am J Med. 2007;120(7):563–7.

    Article  PubMed  Google Scholar 

  45. Lee YY, Lin YM, Leu WJ, Wu MY, Tseng JH, Hsu MT, et al. Sliding-scale insulin used for blood glucose control: a meta-analysis of randomized controlled trials. Metabolism. 2015;64(9):1183–92.

    Article  CAS  PubMed  Google Scholar 

  46. Umpierrez GE, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care. 2011;34(2):256–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Wexler DJ, Beauharnais CC, Regan S, Nathan DM, Cagliero E, Larkin ME. Impact of inpatient diabetes management, education, and improved discharge transition on glycemic control 12 months after discharge. Diabetes Res Clin Pract. 2012;98(2):249–56.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Anderson TS, Lee AK, Jing B, et al. Intensification of Diabetes Medications at Hospital Discharge and Clinical Outcomes in Older Adults in the Veterans Administration Health System. JAMA Netw Open. 2021;4(10):e2128998.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, New York, USA

    Naomi Friedman

  2. Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA

    Hanna J. Lee

Authors
  1. Naomi Friedman
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  2. Hanna J. Lee
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Correspondence to Hanna J. Lee .

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Editors and Affiliations

  1. Division of Endocrinology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA

    Rifka C. Schulman-Rosenbaum

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Friedman, N., Lee, H.J. (2023). Current Standards of Care for Inpatient Type 2 Diabetes Mellitus. In: Schulman-Rosenbaum, R.C. (eds) Diabetes Management in Hospitalized Patients. Contemporary Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-031-44648-1_2

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  • DOI: https://doi.org/10.1007/978-3-031-44648-1_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-44647-4

  • Online ISBN: 978-3-031-44648-1

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