Management of diabetes and hyperglycaemia in the hospital
Open accessAbstract
Hyperglycaemia in people with and without diabetes admitted to the hospital is associated with a substantial increase in morbidity, mortality, and health-care costs. Professional societies have recommended insulin therapy as the cornerstone of inpatient pharmacological management. Intravenous insulin therapy is the treatment of choice in the critical care setting. In non-intensive care settings, several insulin protocols have been proposed to manage patients with hyperglycaemia; however, meta-analyses comparing different treatment regimens have not clearly endorsed the benefits of any particular strategy. Clinical guidelines recommend stopping oral antidiabetes drugs during hospitalisation; however, in some countries continuation of oral antidiabetes drugs is commonplace in some patients with type 2 diabetes admitted to hospital, and findings from clinical trials have suggested that non-insulin drugs, alone or in combination with basal insulin, can be used to achieve appropriate glycaemic control in selected populations. Advances in diabetes technology are revolutionising day-to-day diabetes care and work is ongoing to implement these technologies (ie, continuous glucose monitoring, automated insulin delivery) for inpatient care. Additionally, transformations in care have occurred during the COVID-19 pandemic, including the use of remote inpatient diabetes management-research is needed to assess the effects of such adaptations.
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Meta-analyses of RCTs found a 6 to 7.7 times higher risk ratio for hypoglycemia with intensive insulin therapy versus conventional glycemic control in critically ill patients, and some studies found a risk ratio above 10.
“Meta-analyses of RCTs have reported increased risk ratio of 6 to 7.7 times for occurrence of hypoglycemia with intensive insulin therapy vs conventional glycemic control in critically ill persons,1259,1361 with some studies showing a risk ratio >10.1259”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1259]
The “Diagnostic criteria and glycaemic targets” and “Insulin therapy and hypoglycaemia” sections report increased hypoglycaemia risk with intensive glucose targets in critically ill patients. They do not report meta-analytic risk ratios of 6–7.7 or study estimates above 10 for intensive versus conventional control. The numerical estimates given instead compare basal–bolus with sliding-scale insulin; page numbers are unavailable in our copy. (LLM, conf=0.88)
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Self-citationFuture technology-enabled care for diabetes and hyperglycemia in the hospital setting
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Premixed Insulin Analogue Compared with Basal-Plus Regimen for Inpatient Glycemic Control
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Tight glycaemic control: clinical implementation of protocols
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Self-citation
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Blonde, L., Umpierrez, G. E., Reddy, S. S., McGill, J. B., Berga, S. L., Bush, M., Chandrasekaran, S., DeFronzo, R. A., Einhorn, D., Galindo, R. J., et al. (2022) · Endocrine Practice · doi:10.1016/j.eprac.2022.08.002 · Cited by 507 · see citing works
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Self-citationThe management of diabetes mellitus by mangiferin: advances and prospects
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Self-citationAnnals for hospitalists inpatient notes - how we treat hyperglycemia in the hospital
Pasquel, F. J., & Umpierrez, G. E. (2021) · Annals of Internal Medicine · doi:10.7326/m21-2789 · Cited by 9 · see citing works
Self-citationKatz, A., Shulkin, A., Housni, A., Roy‐Fleming, A., Rabasa‐Lhoret, R., Yale, J., Tsoukas, M. A., Peters, T. M., & Brazeau, A. (2026) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.70465 · Cited by 3 · see citing works
“30 This review therefore evaluates the available evidence on GC-induced hyperglycaemia and associated management strategies across different formulations and routes of administration in the context of T1D.”
- Authors
- Pasquel, F. J., Lansang, M. C., Dhatariya, K., & Umpierrez, G. E.
- Affiliations
- Emory University (US)
- Cleveland Clinic (US)
- Norfolk and Norwich University Hospital (GB)
- Corresponding author
- Pasquel, Francisco J
- Venue
- The Lancet Diabetes & Endocrinology
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 9
- Issue
- 3
- Pages
- 174-188
- ISSN
- 2213-8587 (ISSN-L)
- PMC
- PMC10423081
- OpenAlex
- W3123418238
- Cited by
- 329
- References
- 142
- Citations by year
- 2026: 53 · 2025: 80 · 2024: 62 · 2023: 58 · 2022: 56 · 2021: 20
- FWCI
- 7.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet Diabetes & Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (K23GM128221-03, P30DK111024-05S1, UL1TR002378-04)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- hyperglycemia, insulin therapy, intravenous insulin, intensive care, type 2 diabetes, basal insulin, continuous glucose monitoring, artificial pancreas, COVID-19 pandemic, glycemic control
- MeSH terms
- COVID-19, Blood Glucose, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Hospitalization, Humans, Hyperglycemia, Hypoglycemic Agents, Insulin, Disease Management
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