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16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026

Open access
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, Mandeep, McCoy, Rozalina G., Balapattabi, Kirthikaa, Bannuru, Raveendhara R., Bellini, Natalie J., Bennett, Allison K., Beverly, Elizabeth A. +18 more·2026·Diabetes Care
DOI 10.2337/dc26-s016PMC PMC12690180
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Abstract

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee for Diabetes, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

AI snapshot

Written from the paper’s full text.

TL;DR

This is the American Diabetes Association's 2026 Standards of Care section on inpatient diabetes management, presenting evidence-graded recommendations for hospital glucose monitoring, glycemic targets, insulin and noninsulin therapy, hypoglycemia prevention, perioperative care, hyperglycemic crises, and discharge transitions. It synthesizes trial and observational evidence to define thresholds, treatment protocols, and care-delivery standards for hospitalized adults with diabetes or dysglycemia.

Key findings

  • Glycemic targets: initiate/intensify therapy for persistent hyperglycemia ≥180 mg/dL (≥10.0 mmol/L) confirmed twice in 24 h; goal 140–180 mg/dL (7.8–10.0 mmol/L) for most critically ill individuals and 100–180 mg/dL (5.6–10.0 mmol/L) for noncritically ill individuals if achievable without significant hypoglycemia.
  • NICE-SUGAR found intensive control (80–110 mg/dL) gave no advantage over moderate goals (140–180 mg/dL) and slightly but significantly higher mortality (27.5% vs. 25%), with 10- to 15-fold greater hypoglycemia; a later multicenter trial found tight vs. liberal management hypoglycemia rates of 1.0% vs. 0.7% with no benefit of tight control.
  • A virtual glucose management service reduced hyperglycemia and hypoglycemia rates by 30–40%; bundled hypoglycemia prevention strategies reduced hypoglycemic events by 56–80% versus baseline.
  • Hospital readmission rate for people with diabetes is 14–20%, nearly twice that of people without diabetes; 30% of hospitalized people with diabetes have two or more days of hospital stays, accounting for over 50% of hospital costs for diabetes.

Methods

  • Design: clinical practice guideline/standards document with recommendations graded A, B, C, or E, updated annually by the ADA Professional Practice Committee for Diabetes.
  • Evidence base: narrative synthesis of randomized controlled trials, meta-analyses, systematic reviews, observational and retrospective cohort studies, and consensus reports (e.g., NICE-SUGAR, Van den Berghe, EMPULSE, DIATEC, TIGHT).
  • Content domains: hospital care delivery standards, care teams, glycemic goals, glucose monitoring (POC and CGM), insulin pump/AID use, insulin and noninsulin therapy, hypoglycemia, medical nutrition therapy, self-management, enteral/parenteral feeding, glucocorticoids, perioperative care, DKA/HHS, and hospital-to-ambulatory transitions.

Limitations

  • Stated in the paper: no CGM devices are FDA-approved for inpatient use; data on inpatient hybrid closed-loop/AID use are limited to feasibility trials; data on concentrated insulins in inpatient/perioperative settings are limited and variable; there is insufficient information on mitigating perioperative pulmonary aspiration risk with GLP-1–based medications, and the required withholding duration is unknown; due to lack of interventional data, postponing surgery based on A1C or glucose management indicator alone is not recommended.
  • Stated in the paper: a retrospective SGLT2 inhibitor study relied on ICD-10 codes for DKA diagnosis, so euglycemic DKA cases may have been missed; discrepancies between CGM trials may relate to treatment algorithms rather than the monitoring method.
  • Evident from the text: this is a consensus/guideline synthesis rather than a primary study, so its conclusions depend on the quality and generalizability of the cited literature, and several cited studies are single-center, retrospective, or observational.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2337/dc26-s016

Cites

194 of 194 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

93 of 181 cited sources checked · 39 supported · 2 flagged · accuracy not yet measured

  • Premisecitation
    § Perioperative Care

    The glycemic threshold for an increase in complications is estimated to be somewhere between 100 and 180 mg/dL in most studies.

    “The glycemic threshold for an increase in complications is estimated to be somewhere between 100 and 180 mg/dL (5.5 and 10 mmol/L) in most of these studies (135-138).”
    Quote in the paperSubstantial claim3 of 4 sources checked
    • cites [135] Martin, 2016, Diabetes and risk of surgical site infection: a systematic review and meta-analysis, Infect Control Hosp Epidemiol source

      The Results section (Meta-analysis for blood glucose and SSI) reports that six of ten studies assessing pre-operative glucose and five of eleven assessing post-operative glucose used a 200 mg/dL threshold. The Conclusions (Consistency of Included Studies) likewise says approximately half used lower thresholds and the remaining studies used 200 mg/dL. The paper therefore does not place the threshold between 100 and 180 mg/dL in most studies; it describes thresholds used to define hyperglycemia, not a single estimated point at which complications increase. (LLM, conf=0.85)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [136] King, 2011, Glycemic control and infections in patients with diabetes undergoing noncardiac surgery, Ann Surg source
    • cites [137] Ata, 2010, Postoperative hyperglycemia and surgical site infection in general surgery patients, Arch Surg source

      The COMMENT section reports a 140 mg/dL cutoff for increased surgical-site infection rates in this study, which falls within the claimed range. It does not establish that most studies find a threshold between 100 and 180 mg/dL; the same section describes prior studies as inconclusive and reports some associations above 200 mg/dL. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [138] Kwon, 2013, Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program, Ann Surg source

      The Methods (Data Specification; page not available) define hyperglycemia as glucose above 180 mg/dL, and the Results associate it with increased complications. The paper does not estimate a 100–180 mg/dL threshold or say that this range applies in most studies. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • Premisecitation
    § Insulin Pump Use in the Hospital

    Data on inpatient use of hybrid closed-loop systems (currently commercially available automated insulin delivery [AID] devices) are limited to feasibility trials.

    “Data on inpatient use of hybrid closed-loop systems (currently commercially available automated insulin delivery [AID] devices) are limited to feasibility trials (58).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [58] Davis, 2023, Automated insulin delivery with remote real-time continuous glucose monitoring for hospitalized patients with diabetes: a multicenter, single-arm, feasibility trial, Diabetes Technol Ther source

      The Introduction and Statistical Analysis sections identify this inpatient Omnipod 5 study as a single-arm feasibility trial. They do not establish that data on all commercially available hybrid closed-loop systems are limited to feasibility trials; the Introduction also describes comparative inpatient studies of a different closed-loop system. Page numbers are unavailable in our copy. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation
    § HYPOGLYCEMIA

    Hypoglycemia is associated with increased mortality.

    “While hypoglycemia is associated with increased mortality (97,98), in many cases, it is a marker of an underlying disease rather than the cause of fatality.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [97] Lake, 2019, The effect of hypoglycaemia during hospital admission on health-related outcomes for people with diabetes: a systematic review and meta-analysis, Diabet Med source

      The Results report increased in-hospital mortality among people with diabetes exposed to inpatient hypoglycaemia, supporting the association in that setting. The unqualified claim is broader than the paper’s finding: the Discussion says the association was found outside ICU settings, but not for ICU mortality. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [98] Garg, 2013, Hypoglycemia, with or without insulin therapy, is associated with increased mortality among hospitalized patients, Diabetes Care source
  • Premisecitation
    § Abstract

    Incorporating A1C into the glucose management order set may help increase frequency of A1C testing.

    “Incorporating A1C into the glucose management order set may help increase frequency of A1C testing (6).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [6] Khan, 2024, Increasing frequency of hemoglobin A1c measurements in hospitalized patients with diabetes: a quality improvement project using Lean Six Sigma, J Diabetes Sci Technol source
  • Premisecitation
    § Inpatient Hypoglycemia: Risk Factors, Treatment, and Prevention

    Compared with baseline, studies found that hypoglycemic events decreased by 56-80%.

    “Compared with baseline, studies found that hypoglycemic events decreased by 56-80% (100,107,108).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [100] Sinha Gregory, 2016, Decreased rates of hypoglycemia following implementation of a comprehensive computerized insulin order set and titration algorithm in the inpatient setting, Hosp Pract (1995) source

      The Results section reports that hypoglycemia rates decreased in both study phases, supporting the direction of the claim. But the reported changes—from 1.92% to 1.61% and from 2.57% to 1.82%—are relative decreases of about 16% and 29%, not 56–80%. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites [107] Maynard, 2015, Impact of a hypoglycemia reduction bundle and a systems approach to inpatient glycemic management, Endocr Pract source
    • cites [108] Milligan, 2015, Multifaceted approach to reducing occurrence of severe hypoglycemia in a large healthcare system, Am J Health Syst Pharm source
  • Classified as probably not a substantial claim. 14
  • May combine two claims. 37

  • Classified as probably not a substantial claim.

    Interpretationcitation
    § SELF-MANAGEMENT IN THE HOSPITAL

    Diabetes self-management in the hospital may be appropriate for select individuals who wish to continue to perform self-care while acutely ill.

    “Diabetes self-management in the hospital may be appropriate for select individuals who wish to continue to perform self-care while acutely ill (117-119).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [117] Mabrey, 2015, Patient self-management of diabetes care in the inpatient setting: pro, J Diabetes Sci Technol source
    • cites [118] Shah, 2015, Patient self-management of diabetes care in the inpatient setting: con, J Diabetes Sci Technol source

      The Abstract recommends against diabetes self-management in the hospital, and the Conclusions say health care providers should manage inpatient diabetes because self-management can cause severe hypoglycemia. The paper supports involving patients in decisions and allows continued insulin-pump use under protocols as a special circumstance, but it does not endorse self-management for select patients who wish to continue self-care while acutely ill. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [119] Flanagan, 2018, Self-management of diabetes in hospital: a guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care group, Diabet Med source

  • May combine two claims.

    Premisecitation
    § Glycemic Goals

    The findings from the NICE-SUGAR trial, supported by several meta-analyses, showed higher rates of hypoglycemia and an increase in mortality with more aggressive glycemic management goals compared with moderate glycemic goals.

    “The findings from the NICE-SUGAR trial, supported by several meta-analyses showed higher rates of hypoglycemia and an increase in mortality with more aggressive glycemic management goals compared with moderate glycemic goals (29,32,33).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [29] Umpierrez, 2023, Glucose control in the ICU, N Engl J Med source
    • cites [32] Wiener, 2008, Benefits and risks of tight glucose control in critically ill adults: a meta-analysis, JAMA source
    • cites [33] Adigbli, 2024, A patient-level meta-analysis of intensive glucose control in critically ill adults, NEJM Evid source

      The Introduction (page unavailable) reports that NICE-SUGAR found increased 90-day mortality with a normoglycemia target, and the Discussion says trials and meta-analyses found increased severe hypoglycemia with intensive control. But this paper's own pooled analysis found no significant increase in mortality (Abstract, page unavailable), so it does not support attributing an increased-mortality finding to the meta-analysis. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Insulin Pump Use in the Hospital

    An observational study in children demonstrated improvement in individual satisfaction and improved detection of glycemic excursions with continued use of personal devices.

    “An observational study in children demonstrated improvement in individual satisfaction and improved detection of glycemic excursions with continued use of personal devices (60).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [60] Owens, 2024, Home insulin pump use in hospitalized children with type 1 diabetes, JAMA Netw Open source

      The Methods describe a retrospective study of hospitalized children using home insulin pumps, and the Discussion reports fewer hyperglycemic and hypoglycemic days with home pumps than with injections (page not provided). The paper does not report improved individual satisfaction or test whether personal devices improved detection of glycemic excursions; it measured glucose outcomes instead. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Continuous Glucose Monitoring

    A recent retrospective study demonstrated the feasibility of implementation of a hospital-wide personal CGM policy that included EHR integration and CGM validation for insulin dosing; the policy resulted in favorable hospitalized individual and nurse satisfaction.

    “However, a recent retrospective study demonstrated the feasibility of implementation of a hospital-wide personal CGM policy that included EHR integration and CGM validation for insulin dosing; the policy resulted in favorable hospitalized individual and nurse satisfaction (43).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [43] Lee, 2024, Empowering hospitalized patients with diabetes: implementation of a hospital-wide CGM policy with EHR-integrated validation for dosing insulin, Diabetes Care source

  • May combine two claims.

    Premisecitation
    § Predicting and Preventing Severe Hypoglycemia

    In people with diabetes, an episode of severe hypoglycemia increases the risk for a subsequent event, partly because of impaired counterregulation.

    “In people with diabetes, it is well established that an episode of severe hypoglycemia increases the risk for a subsequent event, partly because of impaired counterregulation (109).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [109] Rickels, 2019, Hypoglycemia-associated autonomic failure, counterregulatory responses, and therapeutic options in type 1 diabetes, Ann N Y Acad Sci source

      In “Mechanisms for the development of hypoglycemia in T1D” (page unavailable), the paper says that people with type 1 diabetes who have both impaired hypoglycemia awareness and a prior severe episode are at substantially increased risk of a future severe episode. “Mechanisms for HAAF in T1D” explains that repeated hypoglycemia blunts counterregulatory defenses. The claim omits the impaired-awareness qualifier, treats a single severe episode as sufficient, and extends the finding beyond type 1 diabetes. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Transitioning From Intravenous to Subcutaneous Insulin

    Emerging data from studies in people with hyperglycemia with and without diabetic ketoacidosis (DKA) show that the administration of a low dose (0.15-0.3 units/kg) of basal insulin analog in addition to intravenous insulin infusion may reduce the duration of insulin infusion and length of hospital stay and prevent rebound hyperglycemia without increased risk of hypoglycemia.

    “Emerging data from studies in people with hyperglycemia with and without diabetic ketoacidosis (DKA) show that the administration of a low dose (0.15-0.3 units/kg) of basal insulin analog in addition to intravenous insulin infusion may reduce the duration of insulin infusion and length of hospital stay and prevent rebound hyperglycemia without increased risk of hypoglycemia (64)(65)(66)(67).”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [64] Thammakosol, 2023, Effectiveness and safety of early insulin glargine administration in combination with continuous intravenous insulin infusion in the management of diabetic ketoacidosis: a randomized controlled trial, Diabetes Obes Metab source
    • cites [65] Hsia, 2012, Subcutaneous administration of glargine to diabetic patients receiving insulin infusion prevents rebound hyperglycemia, J Clin Endocrinol Metab source
    • cites [66] Lim, 2022, Effect of the concomitant use of subcutaneous basal insulin and intravenous insulin infusion in the treatment of severe hyperglycemic patients, Endocrinol Metab (Seoul) source

      The Results and Discussion report less rebound hyperglycemia in both DKA/HHS and non-DKA/HHS subgroups, a shorter hospital stay with 0.25 U/kg basal insulin, and no increase in hypoglycemic events. The Discussion explicitly says the addition of basal insulin did not shorten insulin-infusion duration in this study; that part of the multi-citation claim is not supported by this source. (LLM, conf=0.92)

      Experimental — accuracy not yet measured
    • cites [67] Zhou, 2022, Weight-based insulin during and after intravenous insulin infusion reduces rates of rebound hyperglycemia when transitioning to subcutaneous insulin in the medical intensive care unit, Endocr Pract source

  • May combine two claims.

    Premisecitation
    § Diabetes Care Teams in the Hospital

    Care provided by appropriately trained specialists or specialty teams may reduce the length of stay and improve glycemic and other clinical outcomes.

    “Care provided by appropriately trained specialists or specialty teams may reduce the length of stay and improve glycemic and other clinical outcomes (15)(16)(17).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [15] Akiboye, 2021, Impact of diabetes specialist nurses on inpatient care: a systematic review, Diabet Med source
    • cites [16] Demidowich, 2021, Effects of a dedicated inpatient diabetes management service on glycemic control in a community hospital setting, J Diabetes Sci Technol source
    • cites [17] Haque, 2021, The financial impact of an inpatient diabetes management service, Curr Diab Rep source

  • May combine two claims.

    Premisecitation
    § GLUCOSE MONITORING

    POC blood glucose monitors provide the advantage of immediate bedside results, and studies suggest that while POC measurements are less accurate and less precise than those from laboratory glucose analyzers, they provide adequate information for usual practice except in rare instances where care has been compromised.

    “POC blood glucose monitors provide the advantage of immediate bedside results, and studies suggest that while POC measurements are less accurate and less precise than those from laboratory glucose analyzers, they provide adequate information for usual practice except in rare instances where care has been compromised (40,41).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [40] DuBois, 2017, Bedside glucose monitoring-is it safe? A new, regulatory-compliant risk assessment evaluation protocol in critically ill patient care settings, Crit Care Med source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [41] Zhang, 2017, Performance of a modern glucose meter in ICU and general hospital inpatients: 3 years of real-world paired meter and central laboratory results, Crit Care Med source

  • May combine two claims.

    Premisecitation
    § Inpatient Hypoglycemia: Risk Factors, Treatment, and Prevention

    Kidney failure is an important risk factor for hypoglycemia in the hospital, possibly as a result of decreased insulin clearance.

    “Kidney failure is an important risk factor for hypoglycemia in the hospital (105), possibly as a result of decreased insulin clearance.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [105] Hung, 2018, Risk of hypoglycemia following hospital discharge in patients with diabetes and acute kidney injury, Diabetes Care source

  • May combine two claims.

    Premisecitation
    § Diabetes Care Teams in the Hospital

    Providing diabetes self-management education and developing a diabetes discharge plan that includes continued access to diabetes medications and supplies and ongoing education and support are key strategies to improve long-term outcomes.

    “In addition, providing diabetes self-management education and developing a diabetes discharge plan that includes continued access to diabetes medications and supplies and ongoing education and support are key strategies to improve long-term outcomes (20,21).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [20] Magee, 2021, Diabetes to go-inpatient: pragmatic lessons learned from implementation of technology-enabled diabetes survival skills education within nursing unit workflow in an urban, tertiary care hospital, Jt Comm J Qual Patient Saf source
    • cites [21] Pinkhasova, 2021, Patient understanding of discharge instructions for home diabetes self-management and risk for hospital readmission and emergency department visits, Endocr Pract source

      The Abstract > Conclusion recommends a structured discharge plan for continued diabetes self-management, and the Discussion describes education with postdischarge follow-up. The passages do not establish continued access to medications and supplies as part of that strategy. The Discussion reports outcomes over three months and says whether improvements last longer needs investigation, so the claim about improving long-term outcomes goes beyond this source. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Inpatient Hypoglycemia: Risk Factors, Treatment, and Prevention

    Errors in insulin dosing, missed doses, and/or administration errors including incorrect insulin type and/or timing of dose occur relatively frequently and include prescriber, pharmacy, and nursing errors.

    “Errors in insulin dosing, missed doses, and/or administration errors including incorrect insulin type and/or timing of dose occur relatively frequently (102-104) and include prescriber (ordering), pharmacy (dispensing), and nursing (administration) errors.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [102] Akirov, 2017, Mortality among hospitalized patients with hypoglycemia: insulin related and noninsulin related, J Clin Endocrinol Metab source

      The Discussion (page not provided) reports how often hypoglycemia occurred among hospitalized patients receiving insulin, not how often insulin-dosing or administration errors occurred. The Methods and Discussion do not address missed doses, incorrect insulin type or timing, or prescriber, pharmacy, and nursing errors; searches for those terms and for medication errors found no supporting passage. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [103] Amori, 2008, Inpatient medical errors involving glucose-lowering medications and their impact on patients: review of 2,598 incidents from a voluntary electronic error-reporting database, Endocr Pract source
    • cites [104] Alwan, 2017, Evaluation of the timing and coordination of prandial insulin administration in the hospital, Diabetes Res Clin Pract source

  • May combine two claims.

    Premisecitation
    § Noncritical Care Setting

    Data on the use of concentrated insulins such as glargine U-300, degludec U-200, and U-500 regular insulin in the inpatient and perioperative settings are limited and have shown variable results.

    “Data on the use of concentrated insulins such as glargine U-300, degludec U-200, and U-500 regular insulin in the inpatient and perioperative settings are limited and have shown variable results (78-81).”
    Quote in the paperSubstantial claim2 of 4 sources checked
    • cites [78] Galindo, 2022, 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 source

      The Discussion (page not available) reports an inpatient trial of glargine U-300 and describes earlier hospital studies of degludec as small and preliminary. But this paper's trial compares degludec U-100 with glargine U-100; our copy does not address inpatient or perioperative results for degludec U-200 or U-500 regular insulin, or establish variable results across the listed concentrated insulins. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [79] Pasquel, 2020, A randomized controlled trial comparing glargine U300 and glargine U100 for the inpatient management of medicine and surgery patients with type 2 diabetes: glargine U300 hospital trial, Diabetes Care source
    • cites [80] Perez, 2020, Efficacy and safety of insulin glargine 300 U/mL (Gla-300) during hospitalization and therapy intensification at discharge in patients with insufficiently controlled type 2 diabetes: results of the phase IV COBALTA trial, BMJ Open Diabetes Res Care source

      The Discussion (page unavailable) says evidence on Gla-300 use in hospitals was limited to a small study, and reports this trial’s inpatient results. It does not address inpatient evidence for degludec U-200 or U-500 regular insulin, perioperative use, or variable results across those concentrated insulins. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [81] Tripathy, 2015, U-500 regular insulin use in hospitalized patients, Endocr Pract source

  • May combine two claims.

    Premisecitation
    § Glucocorticoid Therapy

    The prevalence of consistent use of glucocorticoid therapy in hospitalized individuals can approach 10-15%, and these medications can induce hyperglycemia in 56-86% of these individuals with and without preexisting diabetes.

    “The prevalence of consistent use of glucocorticoid therapy in hospitalized individuals can approach 10-15%, and these medications can induce hyperglycemia in 56-86% of these individuals with and without preexisting diabetes (124-126).”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [124] Aberer, 2021, A practical guide for the management of steroid induced hyperglycaemia in the hospital, J Clin Med source

      Section 2 (page not available) reports that 70% of hospitalized patients without a history of diabetes developed hyperglycaemia when given relevant glucocorticoid doses. It does not report that 10–15% of hospitalized people consistently use glucocorticoids, or establish a 56–86% hyperglycaemia range for patients both with and without preexisting diabetes. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [125] Bajaj, 2022, Insulin dosing and glycemic outcomes among steroid-treated hospitalized patients, Endocr Pract source

      The Introduction (page not provided) says that more than half of hospitalized patients receiving high-dose steroids developed hyperglycemia and that steroids can precipitate hyperglycemia with or without preexisting diabetes. It does not give the claimed 56–86% range or say that glucocorticoid use approaches 10–15% among hospitalized patients. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [126] Kleinhans, 2024, Continuous glucose monitoring of steroid-induced hyperglycemia in patients with dermatologic diseases, J Diabetes Sci Technol source

      The Introduction (page unavailable) estimates glucocorticoid therapy in 10% of hospitalized patients and says it can worsen preexisting diabetes or trigger new diabetes. The Discussion (page unavailable) reports that 86% of steroid-treated patients may experience at least one hyperglycemic episode. The paper does not give the claimed 15% therapy prevalence or 56% lower bound for hyperglycemia. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Noncritical Care Setting

    A randomized controlled trial has shown that basal plus bolus insulin plan improved glycemic outcomes and reduced hospital complications compared with a correction or supplemental insulin without basal insulin (formerly known as sliding scale) for people with type 2 diabetes admitted for general surgery.

    “A randomized controlled trial has shown that basal plus bolus insulin plan improved glycemic outcomes and reduced hospital complications compared with a correction or supplemental insulin without basal insulin (formerly known as sliding scale) for people with type 2 diabetes admitted for general surgery (74).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [74] Umpierrez, 2011, 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 source

  • May combine two claims.

    Premisecitation
    § Noncritical Care Setting

    A prospective randomized inpatient study of 70/30 intermediate-acting (NPH)/regular insulin mixture versus basal-bolus therapy showed comparable glycemic outcomes but significantly increased hypoglycemia in the group receiving the insulin mixture.

    “A prospective randomized inpatient study of 70/30 intermediate-acting (NPH)/ regular insulin mixture versus basal-bolus therapy showed comparable glycemic outcomes but significantly increased hypoglycemia in the group receiving the insulin mixture (77).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [77] Bellido, 2015, Comparison of basal-bolus and premixed insulin regimens in hospitalized patients with type 2 diabetes, Diabetes Care source

  • May combine two claims.

    Premisecitation
    § GLUCOSE MONITORING

    The balance between analytic requirements (e.g., accuracy, precision, and interference) and clinical requirements (e.g., rapidity, simplicity, and POC) has not been uniformly resolved, and most hospitals have arrived at their own policies to balance these parameters.

    “The balance between analytic requirements (e.g., accuracy, precision, and interference) and clinical requirements (e.g., rapidity, simplicity, and POC) has not been uniformly resolved (39)(40)(41)(42), and most hospitals have arrived at their own policies to balance these parameters.”
    Quote in the paperNot a substantial claim3 of 4 sources checked
    • cites [39] Sacks, 2023, Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus, Diabetes Care source

      Split into 2 atoms — 1 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [40] DuBois, 2017, Bedside glucose monitoring-is it safe? A new, regulatory-compliant risk assessment evaluation protocol in critically ill patient care settings, Crit Care Med source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [41] Zhang, 2017, Performance of a modern glucose meter in ICU and general hospital inpatients: 3 years of real-world paired meter and central laboratory results, Crit Care Med source
    • cites [42] Misra, 2023, How can point-of-care technologies support in-hospital diabetes care?, J Diabetes Sci Technol source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Diabetes Care Teams in the Hospital

    The increased risk of 30-day readmission following hospitalization that has been attributed to diabetes can be reduced, and costs saved, when inpatient care is provided by a diabetes management team.

    “In addition, the increased risk of 30-day readmission following hospitalization that has been attributed to diabetes can be reduced, and costs saved, when inpatient care is provided by a diabetes management team (15,18).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [15] Akiboye, 2021, Impact of diabetes specialist nurses on inpatient care: a systematic review, Diabet Med source
    • cites [18] Bansal, 2018, Inpatient diabetes management by specialized diabetes team versus primary service team in non-critical care units: impact on 30-day readmission rate and hospital cost, BMJ Open Diabetes Res Care source

  • May combine two claims.

    Premisecitation
    § Noncritical Care Setting

    Several reports indicate that inpatient use of insulin pens is safe and may improve nurse satisfaction when safety protocols, including nursing education and bar code scanning procedures, are in place to guarantee single-person use.

    “Several reports indicate that inpatient use of insulin pens is safe and may improve nurse satisfaction when safety protocols, including nursing education and bar code scanning procedures, are in place to guarantee single-person use (70-73).”
    Quote in the paperNot a substantial claim1 of 4 sources checked
    • cites [70] Veronesi, 2015, Determinants of nurse satisfaction using insulin pen devices with safety needles: an exploratory factor analysis, Clin Diabetes Endocrinol source

      The Discussion reports that about 92% of nurses considered pens with safety needles an improvement, and that no needlestick injuries occurred during the three-month pen-use period. The Methods describe nurse training, but the paper does not report bar-code scanning or a procedure guaranteeing single-person use; its Background also describes inpatient adoption as controversial because of contamination risks. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [71] Institute for Safe Medication Practices . ISMP guidelines for optimizing safe subcutaneous insulin use in adults, 2017. Accessed 4 August 2025. Available from https://www.ismp.org/sites/default/files/attachments/2018-09/ISMP138D-Insulin%20Guideline-090718.pdf.

      Not checked in the free run.

    • cites [72] Najmi, 2021, Inpatient insulin pen implementation, waste, and potential cost savings: a community hospital experience, J Diabetes Sci Technol source
    • cites [73] MacMaster, 2019, Development and Implementation of a subcutaneous insulin pen label bar code scanning protocol to prevent wrong-patient insulin pen errors, Jt Comm J Qual Patient Saf source

  • May combine two claims.

    Premisecitation
    § GLP-1 or Dual GIP and GLP-1 RAs and the Perioperative Period

    GLP-1-based medications may be associated with nausea, vomiting, and delayed gastric emptying, and there have been case reports of pulmonary aspiration during general anesthesia and deep sedation.

    “These medications may be associated with nausea, vomiting, and delayed gastric emptying, and there have been case reports of pulmonary aspiration during general anesthesia and deep sedation (154).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [154] Klein, 2023, Semaglutide, delayed gastric emptying, and intraoperative pulmonary aspiration: a case report, Can J Anaesth source

      The Discussion identifies nausea and vomiting as prevalent GLP-1 agonist side effects and describes delayed gastric emptying associated with semaglutide in this patient. The Case presentation reports pulmonary aspiration during a procedure initiated under deep sedation. This paper presents one case; it does not report a separate case of aspiration during general anesthesia. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

    Hyperglycemic crisis rates among people with type 2 diabetes are up to 3.2 per 1,000 person-years.

    “and up to 3.2 per 1,000 personyears among people with type 2 diabetes (169).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [169] McCoy, 2023, Rates of hypoglycemic and hyperglycemic emergencies among U.S. adults with diabetes, 2011–2020, Diabetes Care source

      The Results (passage [4]; page not provided) report a severe-hyperglycemia rate of 3.2 per 1,000 person-years among people with type 2 diabetes in 2020. But the rate reached 3.3 in 2019, so 3.2 was not the upper limit reported by this study. The rates concern ED visits or hospitalizations among privately insured and Medicare Advantage beneficiaries. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Perioperative Care

    Surgical stress and counterregulatory hormone release increase the risk of hyperglycemia as well as mortality, infection, and length of stay.

    “Surgical stress and counterregulatory hormone release increase the risk of hyperglycemia as well as mortality, infection, and length of stay (131,132).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [131] Cheng, 2021, Insulin management in hospitalized patients with diabetes mellitus on high-dose glucocorticoids: management of steroid-exacerbated hyperglycemia, PLoS One source

      The Introduction (page unavailable) associates hyperglycemia in hospitalized patients with mortality, infection, and longer hospital stays, and describes glucocorticoids as a cause of hyperglycemia. It does not attribute those effects to surgical stress or counterregulatory hormone release; the mechanisms it discusses concern glucocorticoid treatment. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [132] Todd, 2021, Evaluating perioperative glycemic control of non-cardiac surgical patients with diabetes, Mil Med source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

    DKA and HHS are serious, acute, and life-threatening hyperglycemic emergencies in individuals with diabetes that incur substantial morbidity, mortality, and costs.

    “DKA and the hyperglycemic hyperosmolar state (HHS) are serious, acute, and lifethreatening hyperglycemic emergencies in individuals with diabetes (165) that incur substantial morbidity, mortality, and costs (166).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [165] Umpierrez, 2024, Hyperglycemic crises in adults with diabetes: a consensus report, Diabetes Care source
    • cites [166] Desai, 2018, health care utilization and burden of diabetic ketoacidosis in the U.S. over the past decade: a nationwide analysis, Diabetes Care source

  • May combine two claims.

    Premisecitation
    § TRANSITION FROM THE HOSPITAL TO THE AMBULATORY SETTING

    A structured discharge plan tailored to the individual may reduce length of hospital stay and readmission rates and increase satisfaction with the hospital experience.

    “A structured discharge plan tailored to the individual may reduce the length of hospital stay and readmission rates and increase satisfaction with the hospital experience (183).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [183] Gonçalves-Bradley, 2022, Discharge planning from hospital, Cochrane Database Syst Rev source

      The Authors’ conclusions (p. 5) support a small reduction in hospital stay and readmissions and a possible slight increase in patient satisfaction. However, those findings are stated for older people with a medical condition; the citing sentence omits that population limit. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • Rests on an assumption: The transition from the acute care setting presents risks for all people with diabetes.

  • May combine two claims.

    Premisecitation
    § Perioperative Care

    Current data suggest an optimal A1C goal between 7% and 8% preoperatively, as it is associated with better glycemic management in the perioperative period and decreased length of hospital stay.

    “Current data also suggest an optimal A1C goal between 7% and 8% preoperatively, as it is associated with better glycemic management in the perioperative period and decreased length of hospital stay (139,141-144).”
    Quote in the paperSubstantial claim2 of 5 sources checked
    • cites [139] Garg, 2018, Effect of preoperative diabetes management on glycemic control and clinical outcomes after elective surgery, Ann Surg source
    • cites [141] Underwood, 2014, Preoperative A1C and clinical outcomes in patients with diabetes undergoing major noncardiac surgical procedures, Diabetes Care source
    • cites [142] Chen, 2018, The effect of elevated A1C on immediate postoperative complications: a prospective observational study, Clin Diabetes source

      The Results and Discussion report that patients with A1C ≥7% had higher postoperative glucose levels and wider variability than those with A1C <7%, supporting an association with perioperative glycemic management. The study does not identify 7–8% as an optimal preoperative goal or show that this range decreases total hospital stay; its Results report intensive care unit stay, which is a different measure. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [143] Yu, 2024, Impact of preoperative haemoglobin A1c levels on postoperative outcomes in adults undergoing major noncardiac surgery: a systematic review, Diabet Med source

      The Discussion reports that higher preoperative HbA1c was associated with higher postoperative glucose, and §3.8.1 reports that three of four studies linked higher HbA1c to longer hospital stays. But the review does not establish 7%–8% as an optimal preoperative goal: one study found longer stays at HbA1c ≥7%, while another found shorter stays in a 6.5%–8% group than in a >8% group. No page numbers are available in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [144] Tao, 2023, Preoperative HbA1c and postoperative outcomes in spine surgery: a systematic review and meta-analysis, Spine (Phila Pa 1976) source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation
    § Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

    The higher mortality rates in low- and middle-income countries may be due to delayed diagnosis and treatment.

    “potentially because of delayed diagnosis and treatment (165).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [165] Umpierrez, 2024, Hyperglycemic crises in adults with diabetes: a consensus report, Diabetes Care source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

    Hyperglycemic crisis rates among people with type 1 diabetes are up to 44.5-82.6 per 1,000 person-years.

    “Recent data suggest hyperglycemic crisis rates of up to 44.5-82.6 per 1,000 person-years among people with type 1 diabetes (169,172)”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [169] McCoy, 2023, Rates of hypoglycemic and hyperglycemic emergencies among U.S. adults with diabetes, 2011–2020, Diabetes Care source

      The study results report an adjusted severe-hyperglycemia rate of 44.5 per 1,000 person-years in 2020 among adults with type 1 diabetes. They report 47.2 in 2019, but do not report the claimed upper value of 82.6; the estimates also concern ED visits and hospitalizations among privately insured and Medicare Advantage beneficiaries. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [172] O’Reilly, 2021, Rising rates and widening socioeconomic disparities in diabetic ketoacidosis in type 1 diabetes in scotland: a nationwide retrospective cohort observational study, Diabetes Care source

      The Results in our copy’s Abstract report 30,427 diabetic ketoacidosis admissions over 393,223 person-years in people with type 1 diabetes, equivalent to about 77.4 per 1,000 person-years. That supports a rate within the claimed range, but our copy does not report the specific 44.5–82.6 range or rates for hyperglycemic crises beyond diabetic ketoacidosis. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation
    § Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

    Approximately 10% of people experiencing DKA present with euglycemic DKA (plasma glucose <200 mg/dL); therefore, DKA diagnosis requires either the presence of hyperglycemia or prior history of diabetes.

    “Importantly, approximately 10% of people experiencing DKA present with euglycemic DKA (plasma glucose <200 mg/dL [<11.1 mmol/L]); therefore, DKA diagnosis requires either the presence of hyperglycemia or prior history of diabetes (165).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [165] Umpierrez, 2024, Hyperglycemic crises in adults with diabetes: a consensus report, Diabetes Care source

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given
    § HYPOGLYCEMIA

    Many episodes of inpatient hypoglycemia are preventable.

    “Many episodes of inpatient hypoglycemia are preventable.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § STANDARDS FOR SPECIAL SITUATIONS Enteral and Parenteral Feedings

    Commercially available enteral nutrition preparations contain variable amounts of carbohydrates and may be infused at different rates that may affect nutritional insulin needs.

    “Commercially available enteral nutrition preparations contain variable amounts of carbohydrates and may be infused at different rates (116) that may affect nutritional insulin needs.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [116] Korytkowski, 2016

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Abstract

    Systematic reviews of randomized controlled trials using computerized assistance to improve glycemic outcomes in the hospital found significant improvement in the percentage of time individuals spent in the glycemic goal range, lower mean blood glucose levels, and no increase in hypoglycemia.

    “Systematic reviews of randomized controlled trials using computerized assistance to improve glycemic outcomes in the hospital found significant improvement in the percentage of time individuals spent in the glycemic goal range, lower mean blood glucose levels, and no increase in hypoglycemia (11).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Sly, 2022, Digital interventions to improve safety and quality of inpatient diabetes management: a systematic review, Int J Med Inform source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Abstract

    The National Academy of Medicine recommends CPOE to prevent medication-related errors and to increase medication administration efficiency.

    “The National Academy of Medicine recommends CPOE to prevent medication-related errors and to increase medication administration efficiency (10).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Institute of Medicine, 2007 source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § Abstract

    High-quality hospital care for diabetes requires clear and actionable standards for care delivery, which are best implemented using structured order sets with computerized provider order entry (CPOE) as well as quality improvement strategies for process improvement.

    “High-quality hospital care for diabetes requires clear and actionable standards for care delivery, which are best implemented using structured order sets with computerized provider order entry (CPOE) as well as quality improvement strategies for process improvement (9).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Kravchenko, 2020, Impact of structured insulin order sets on inpatient hypoglycemia and glycemic control, Endocr Pract source

  • May combine two claims.

    Premisecitation
    § Predicting and Preventing Severe Hypoglycemia

    In another study of hypoglycemic episodes (defined as <50 mg/dL), 78% of individuals were taking basal insulin, with the incidence of hypoglycemia peaking between midnight and 6:00 A.M.

    “In another study of hypoglycemic episodes (defined as <50 mg/dL [<2.8 mmol/L]), 78% of individuals were taking basal insulin, with the incidence of hypoglycemia peaking between midnight and 6:00 A.M. (111).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [111] Ulmer, 2015, Temporal occurrences and recurrence patterns of hypoglycemia during hospitalization, Endocr Pract source

  • May combine two claims.

    Premisecitation
    § Type 1 Diabetes

    Insulin dosing based solely on premeal glucose levels does not account for basal insulin requirements or caloric intake and increases the risk of both hypoglycemia and hyperglycemia.

    “insulin dosing based solely on premeal glucose levels does not account for basal insulin requirements or caloric intake and increases the risk of both hypoglycemia and hyperglycemia (83).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [83] Mendez, 2017, Management of type 1 diabetes in the hospital setting, Curr Diab Rep source

  • May combine two claims.

    Premisecitation
    § Noncritical Care Setting

    Use of insulin analogs or human insulin results in similar glycemic outcomes in the hospital setting, but human insulin may increase the risk of hypoglycemic events.

    “Use of insulin analogs or human insulin results in similar glycemic outcomes in the hospital setting, but human insulin may increase the risk of hypoglycemic events (68).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [68] Bueno, 2015, Basal-bolus regimen with insulin analogues versus human insulin in medical patients with type 2 diabetes: a randomized controlled trial in Latin America, Endocr Pract source

  • May combine two claims.

    Premisecitation
    § Glycemic Goals

    In the NICE-SUGAR trial, critically ill individuals randomized to intensive glycemic management (80-110 mg/dL) derived no significant treatment advantage compared with a group with more moderate glycemic goals (140-180 mg/dL) and had slightly but significantly higher mortality (27.5% vs. 25%).

    “In the NICE-SUGAR trial, critically ill individuals randomized to intensive glycemic management (80-110 mg/dL [4.4-6.1 mmol/L]) derived no significant treatment advantage compared with a group with more moderate glycemic goals (140-180 mg/dL [7.8-10.0mmol/L]) and had slightly but significantly higher mortality (27.5% vs. 25%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Continuous Glucose Monitoring

    Both groups in that trial achieved similar mean blood glucose levels (170 ± 32 vs. 175 ± 33 [P = 0.25]) with similarly low levels of hypoglycemia.

    “Both groups achieved similar mean blood glucose levels (170 ± 32 vs. 175 ± 33 [P = 0.25]) with similarly low levels of hypoglycemia.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [53] Hirsch, 2025, Results from a randomized trial of intensive glucose management using CGM versus usual care in hospitalized adults with type 2 diabetes: the TIGHT study, Diabetes Care source

  • May combine two claims.

    Premisecitation
    § Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

    Use of bicarbonate in people with DKA makes no difference in the resolution of acidosis or time to discharge.

    “Several studies have shown that the use of bicarbonate in people with DKA made no difference in the resolution of acidosis or time to discharge”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

    Euglycemic DKA develops in the presence of low insulin levels and can be associated with a variety of factors including reduced food intake, pregnancy, alcohol use, liver failure, and/or SGLT2 inhibitor therapy.

    “Euglycemic DKA develops in the presence of low insulin levels and can be associated with a variety of factors including reduced food intake, pregnancy, alcohol use, liver failure, and/or SGLT2 inhibitor therapy (167).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [167] Long, 2021, Euglycemic diabetic ketoacidosis: etiologies, evaluation, and management, Am J Emerg Med source

  • May combine two claims.

    Interpretationnone given
    § Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

    Subcutaneous rapid-acting insulin treatment for mild and uncomplicated DKA may be safer and more cost-effective than treatment with intravenous insulin.

    “This approach may be safer and more cost-effective than treatment with intravenous insulin.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given
    § Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

    Approximately 1% of all hospitalizations in people with diabetes are for hyperglycemic crises.

    “Approximately 1% of all hospitalizations in people with diabetes are for hyperglycemic crises.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

    DKA and HHS often present concurrently, though few studies have examined mixed DKA-HHS events.

    “Additionally, DKA and HHS often present concurrently (168), though few studies have examined mixed DKA-HHS events.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [168] Pasquel, 2020, Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: a retrospective, hospital-based cohort study, Diabetes Care source

  • May combine two claims.

    Premisecitation
    § PREVENTING ADMISSIONS AND READMISSIONS

    Factors contributing to readmission among people with diabetes include male sex, longer duration of prior hospitalization, number of previous hospitalizations, number and severity of comorbidities, and lower socioeconomic and/or educational status.

    “Factors contributing to readmission include male sex, longer duration of prior hospitalization, number of previous hospitalizations, number and severity of comorbidities, and lower socioeconomic and/or educational status”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [184] Gregory, 2018, Strategies to prevent readmission in high-risk patients with diabetes: the importance of an interdisciplinary approach, Curr Diab Rep source
    • cites [190] Rubin, 2015, Hospital readmission of patients with diabetes, Curr Diab Rep source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

    People discharged after an episode of DKA have a 1-year age-corrected mortality rate that is 13 times higher than the general population.

    “People discharged after an episode of DKA have a 1-year age-corrected mortality rate that is 13 times higher than the general population (177).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [177] Shand, 2022, Mortality after discharge from hospital following an episode of diabetic ketoacidosis, Acta Diabetol source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

    DKA mortality decreased in the first decade of the 21st century.

    “While DKA mortality decreased in the first decade of the 21st century (166)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [166] Desai, 2018, health care utilization and burden of diabetic ketoacidosis in the U.S. over the past decade: a nationwide analysis, Diabetes Care source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given
    § PREVENTING ADMISSIONS AND READMISSIONS

    Age is an important risk factor in hospitalization and readmission among people with diabetes.

    “Age is also an important risk factor in hospitalization and readmission among people with diabetes (refer to section 13, “Older Adults,” for detailed information).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § PREVENTING ADMISSIONS AND READMISSIONS

    For people with diabetes, the hospital readmission rate is between 14% and 20%.

    “For people with diabetes, the hospital readmission rate is between 14% and 20%”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [184] Gregory, 2018, Strategies to prevent readmission in high-risk patients with diabetes: the importance of an interdisciplinary approach, Curr Diab Rep source
    • cites [190] Rubin, 2015, Hospital readmission of patients with diabetes, Curr Diab Rep source
47 of 47

  • The paper relies on this without support.

    Identification and careful management of people with diabetes and dysglycemia during hospitalization has direct and immediate benefits.

    “Identification and careful management of people with diabetes and dysglycemia during hospitalization has direct and immediate benefits.”

  • The paper relies on this without support.

    These steps can improve outcomes, shorten hospital stays, and reduce the need for readmission and emergency department visits.

    “These steps can improve outcomes, shorten hospital stays, and reduce the need for readmission and emergency department visits.”

  • The paper relies on this without support.

    At this time, none of the CGM devices have been approved by the FDA for inpatient use.

    “However, at this time, none of the CGM devices have been approved by the FDA for inpatient use.”

  • The paper relies on this without support.

    Continuous intravenous insulin infusion is the most effective method for achieving specific glycemic goals and avoiding hypoglycemia in the critical care setting.

    “Continuous intravenous insulin infusion is the most effective method for achieving specific glycemic goals and avoiding hypoglycemia in the critical care setting.”

  • The paper relies on this without support.

    Many institutions still require POC blood glucose monitoring with variable frequency (1-6 times daily) for individuals continuing insulin pump or AID system use.

    “Many institutions still require POC blood glucose monitoring with variable frequency (1-6 times daily) for individuals continuing insulin pump or AID system use.”

  • The paper relies on this without support.

    The transition from the acute care setting presents risks for all people with diabetes.

    “The transition from the acute care setting presents risks for all people with diabetes.”

  • The paper relies on this without support.

    Acute illness increases the risk of both hypoglycemia and hyperglycemia in people with diabetes.

    “Inpatient diabetes management is challenging for hospitals, health care professionals, and people with diabetes, as acute illness increases the risk of both hypoglycemia and hyperglycemia.”
7 of 7

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • CGM validation rules disagree at 70 mg/dL

    Minor

    The first rule requires a CGM reading at a blood glucose of exactly 70 mg/dL to be within 20% of the reference measurement (14 mg/dL). The later rule allows a difference of 20 mg/dL at that same value.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Colunga-Lozano, 2018, Sliding scale insulin for non-critically ill hospitalised adults with diabetes mellitus, Cochrane Database Syst Rev, 11, CD011296
  2. Korytkowski, 2016, Managing Diabetes and Hyperglycemia in the Hospital Setting, 70
  3. El-Mohandes, 2025, Pediatric diabetic ketoacidosis.

Cited by

Sorted by citations

Authors
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., Drincic, A., Echouffo-Tcheugui, J. B., Everett, B. M., Garg, R., Laffel, L. M., Lal, R., Matfin, G., Pandya, N., Pekas, E. J., Peters, A. L., Pilla, S. J., Romeo, G. R., Rosas, S. E., Segal, A. R., Szmuilowicz, E. D., & ElSayed, N. A.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2025-12-08
Volume
49
Issue
Supplement_1
Pages
S339-S355
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc26-s016
PMC
PMC12690180
OpenAlex
W4417121386
Semantic Scholar
7025044750eab1623602f1a8eb6b8025c721c0de
Cited by
80
References
175
Citations by year
2026: 80
FWCI
11.08
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/content/license (vor)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
hospital care, inpatient diabetes management, clinical guidelines, quality of care, treatment goals, level of evidence
MeSH terms
Diabetes Mellitus, Hospitals, Humans, Standard of Care

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-27.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-27.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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