is common in hospitalized people, even among those without a previous history of diabetes, and is associated with increased in-hospital complications, longer length of stay and mortality. • Insulin is the most appropriate pharmacologic agent for effectively controlling glycemia in hospital. A proactive approach to glycemic management using scheduled basal, bolus and correction (supplemental) insulin is the preferred method. The use of correction-only (supplemental) insulin, which treats hyperglycemia only after it has occurred, should be discouraged as the sole modality for treating elevated blood glucose levels. • For the majority of noncritically ill hospitalized people with diabetes, preprandial blood glucose targets should be 5.0 to 8.0 mmol/L, in conjunction with random blood glucose values <10.0 mmol/L, as long as these targets can be safely achieved. For critically ill hospitalized people with diabetes, blood glucose levels should be maintained between 6.0 and 10.0 mmol/L. • Hypoglycemia is a major barrier to achieving targeted glycemic control in the hospital setting. Health-care institutions should develop protocols for the assessment and treatment of hypoglycemia. KEY MESSAGES FOR PEOPLE WITH DIABETES • If your admission to hospital is planned, talk with your health-care providers (e.g. surgeon, anesthetist, primary care provider, diabetes health provider, etc.) before you are admitted in order to develop an in-hospital diabetes care plan that addresses such issues as: • Who will manage your diabetes in the hospital? • Will you be able to self-manage your diabetes? • What adjustments to your diabetes medications or insulin doses may be necessary before and after medical procedures or surgery? • If you use an insulin pump, are hospital staff familiar with pump therapy? • Your blood glucose levels may be higher in hospital than your usual target range due to a variety of factors, including the stress of your illness, medications, medical procedures and infections. • Your diabetes medications may need to be changed during your hospital stay to manage the changes in blood glucose, or if medical conditions develop that make some medications no longer safe to use. • When you are discharged, make sure that you have written instructions about: • Changes in your dosage of medications or insulin injections or any new medications or treatments • How often to check your blood glucose • Who to contact if you have difficulty managing your blood glucose levels. Screening for and Diagnosis of Diabetes and Hyperglycemia in the Hospital Setting A history of diabetes should be elicited in all patients admitted to hospital and, if present, should be clearly identified on the medical record. In view of the high prevalence of inpatient hyperglycemia with associated poor outcomes, an admission BG measurement of all patients would help identify people with diabetes, even in the absence of a prior diagnosis (1,5). In-hospital hyperglycemia is defined as any glucose value >7.8 mmol/L. For hospitalized people with known diabetes,...
