15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2021

Abstract

The American Diabetes Association (ADA) “Standards of Medical 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, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), 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, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Impact of undiagnosed type 2 diabetes and pre-diabetes on severity and mortality for SARS-CoV-2 infection

“…18 De novo/intrahospital hyperglycemia was defined as FPG ≥140 mg/dL in cases without diabetes and normal HbA1c. 19 Follow-up time was estimated from date of symptom onset to last follow-up (censoring) or death, whichever occurred first.…”

A Practical Guide for the Management of Steroid Induced Hyperglycaemia in the Hospital

“…In hospitalized patients a target glucose range of 7.8–10.0 mmol/L (140–180 mg/dL) is recommended for the majority of critically and non-critically ill patients. More stringent goals such as 6.1–7.8 mmol/L (110–140 mg/dL) may be appropriate for selected patients, if this goal can be achieved without relevant hypoglycaemia [ 30 ]. However, when aiming to achieve lower target glucose levels it has to be considered that people with SIHG often suffer from severe underlying disease (e.g., cancer), are in the perioperative care setting (e.g., recently transplanted patients or those requiring steroids as supportive therapy [ 31 ]), receive concomitant complex therapies (chemotherapy, immunosuppressants, antimicrobial therapy, etc.)…”

“…OHAs might be an adequate choice in inpatients with stable and non-critical disease and mild hyperglycaemic excursions. In those with significant hyperglycaemia and severe illness, insulin remains the treatment of choice in the hospital setting as also suggested by the current guidelines for inpatient diabetes management [ 30 ].…”

“…During critical illness, factors such as stress, inflammation, failure of kidney function or administered therapeutics, specifically GCs, detrimentally impact on glucose metabolism in people with and without previously known diabetes. In most of patients with critical illness and hyperglycaemia, insulin therapy should be introduced as continuous intravenous application [ 30 ]. Intravenous insulin provides the advantage of more rapid insulin adjustments to hyperglycaemic levels.…”

The Endocrine Hospitalist: Enhancing the Quality of Diabetes Care

“…9 The American Diabetes Association has been recommending for several years to "consult with specialized diabetes or glucose management teams" when caring for hospitalized patients with diabetes. [10][11][12][13] Despite numerous efforts by the endocrine and diabetes community to improve diabetes care for hospitalized patients, care remains suboptimal. Many hospitals still rely mostly on correctional/sliding scale rapid-acting insulin, a potentially harmful "reflexive behavior" which compares unfavorably to physiologically scheduled insulin.…”