Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline
Adult patients with diabetes or newly recognized hyperglycemia account for over 30% of noncritically ill hospitalized patients. These patients are at increased risk for adverse clinical outcomes in the absence of defined approaches to glycemic management. To review and update the 2012 Management of...
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| Veröffentlicht in: | The journal of clinical endocrinology and metabolism Jg. 107; H. 8; S. 2101 |
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| Sprache: | Englisch |
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01.08.2022
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| ISSN: | 1945-7197, 1945-7197 |
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| Abstract | Adult patients with diabetes or newly recognized hyperglycemia account for over 30% of noncritically ill hospitalized patients. These patients are at increased risk for adverse clinical outcomes in the absence of defined approaches to glycemic management.
To review and update the 2012 Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline and to address emerging areas specific to the target population of noncritically ill hospitalized patients with diabetes or newly recognized or stress-induced hyperglycemia.
A multidisciplinary panel of clinician experts, together with a patient representative and experts in systematic reviews and guideline development, identified and prioritized 10 clinical questions related to inpatient management of patients with diabetes and/or hyperglycemia. The systematic reviews queried electronic databases for studies relevant to the selected questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations.
The panel agreed on 10 frequently encountered areas specific to glycemic management in the hospital for which 15 recommendations were made. The guideline includes conditional recommendations for hospital use of emerging diabetes technologies including continuous glucose monitoring and insulin pump therapy; insulin regimens for prandial insulin dosing, glucocorticoid, and enteral nutrition-associated hyperglycemia; and use of noninsulin therapies. Recommendations were also made for issues relating to preoperative glycemic measures, appropriate use of correctional insulin, and diabetes self-management education in the hospital. A conditional recommendation was made against preoperative use of caloric beverages in patients with diabetes.
The recommendations are based on the consideration of important outcomes, practicality, feasibility, and patient values and preferences. These recommendations can be used to inform system improvement and clinical practice for this frequently encountered inpatient population. |
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| AbstractList | Adult patients with diabetes or newly recognized hyperglycemia account for over 30% of noncritically ill hospitalized patients. These patients are at increased risk for adverse clinical outcomes in the absence of defined approaches to glycemic management.
To review and update the 2012 Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline and to address emerging areas specific to the target population of noncritically ill hospitalized patients with diabetes or newly recognized or stress-induced hyperglycemia.
A multidisciplinary panel of clinician experts, together with a patient representative and experts in systematic reviews and guideline development, identified and prioritized 10 clinical questions related to inpatient management of patients with diabetes and/or hyperglycemia. The systematic reviews queried electronic databases for studies relevant to the selected questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations.
The panel agreed on 10 frequently encountered areas specific to glycemic management in the hospital for which 15 recommendations were made. The guideline includes conditional recommendations for hospital use of emerging diabetes technologies including continuous glucose monitoring and insulin pump therapy; insulin regimens for prandial insulin dosing, glucocorticoid, and enteral nutrition-associated hyperglycemia; and use of noninsulin therapies. Recommendations were also made for issues relating to preoperative glycemic measures, appropriate use of correctional insulin, and diabetes self-management education in the hospital. A conditional recommendation was made against preoperative use of caloric beverages in patients with diabetes.
The recommendations are based on the consideration of important outcomes, practicality, feasibility, and patient values and preferences. These recommendations can be used to inform system improvement and clinical practice for this frequently encountered inpatient population. Adult patients with diabetes or newly recognized hyperglycemia account for over 30% of noncritically ill hospitalized patients. These patients are at increased risk for adverse clinical outcomes in the absence of defined approaches to glycemic management.BACKGROUNDAdult patients with diabetes or newly recognized hyperglycemia account for over 30% of noncritically ill hospitalized patients. These patients are at increased risk for adverse clinical outcomes in the absence of defined approaches to glycemic management.To review and update the 2012 Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline and to address emerging areas specific to the target population of noncritically ill hospitalized patients with diabetes or newly recognized or stress-induced hyperglycemia.OBJECTIVETo review and update the 2012 Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline and to address emerging areas specific to the target population of noncritically ill hospitalized patients with diabetes or newly recognized or stress-induced hyperglycemia.A multidisciplinary panel of clinician experts, together with a patient representative and experts in systematic reviews and guideline development, identified and prioritized 10 clinical questions related to inpatient management of patients with diabetes and/or hyperglycemia. The systematic reviews queried electronic databases for studies relevant to the selected questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations.METHODSA multidisciplinary panel of clinician experts, together with a patient representative and experts in systematic reviews and guideline development, identified and prioritized 10 clinical questions related to inpatient management of patients with diabetes and/or hyperglycemia. The systematic reviews queried electronic databases for studies relevant to the selected questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations.The panel agreed on 10 frequently encountered areas specific to glycemic management in the hospital for which 15 recommendations were made. The guideline includes conditional recommendations for hospital use of emerging diabetes technologies including continuous glucose monitoring and insulin pump therapy; insulin regimens for prandial insulin dosing, glucocorticoid, and enteral nutrition-associated hyperglycemia; and use of noninsulin therapies. Recommendations were also made for issues relating to preoperative glycemic measures, appropriate use of correctional insulin, and diabetes self-management education in the hospital. A conditional recommendation was made against preoperative use of caloric beverages in patients with diabetes.RESULTSThe panel agreed on 10 frequently encountered areas specific to glycemic management in the hospital for which 15 recommendations were made. The guideline includes conditional recommendations for hospital use of emerging diabetes technologies including continuous glucose monitoring and insulin pump therapy; insulin regimens for prandial insulin dosing, glucocorticoid, and enteral nutrition-associated hyperglycemia; and use of noninsulin therapies. Recommendations were also made for issues relating to preoperative glycemic measures, appropriate use of correctional insulin, and diabetes self-management education in the hospital. A conditional recommendation was made against preoperative use of caloric beverages in patients with diabetes.The recommendations are based on the consideration of important outcomes, practicality, feasibility, and patient values and preferences. These recommendations can be used to inform system improvement and clinical practice for this frequently encountered inpatient population.CONCLUSIONThe recommendations are based on the consideration of important outcomes, practicality, feasibility, and patient values and preferences. These recommendations can be used to inform system improvement and clinical practice for this frequently encountered inpatient population. |
| Author | Donihi, Amy C Antinori-Lent, Kellie McDonnell, Marie E Santesso, Nancy Murad, M Hassan Muniyappa, Ranganath Umpierrez, Guillermo E Luger, Anton Hirsch, Irl B Pegg, Claire Rushakoff, Robert J Nielsen, Craig Korytkowski, Mary T Drincic, Andjela T |
| Author_xml | – sequence: 1 givenname: Mary T orcidid: 0000-0001-7131-8903 surname: Korytkowski fullname: Korytkowski, Mary T organization: University of Pittsburgh, Division of Endocrinology, Department of Medicine, Pittsburgh, PA, USA – sequence: 2 givenname: Ranganath surname: Muniyappa fullname: Muniyappa, Ranganath organization: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA – sequence: 3 givenname: Kellie surname: Antinori-Lent fullname: Antinori-Lent, Kellie organization: UPMC Shadyside, Nursing Education & Research, Pittsburgh, PA, USA – sequence: 4 givenname: Amy C surname: Donihi fullname: Donihi, Amy C organization: University of Pittsburgh School of Pharmacy, Department of Pharmacy and Therapeutics, Pittsburgh, PA, USA – sequence: 5 givenname: Andjela T surname: Drincic fullname: Drincic, Andjela T organization: University of Nebraska Medical Center, Endocrinology & Metabolism, Omaha, NE, USA – sequence: 6 givenname: Irl B surname: Hirsch fullname: Hirsch, Irl B organization: University of Washington Diabetes Institute, Seattle, WA, USA – sequence: 7 givenname: Anton surname: Luger fullname: Luger, Anton organization: Medical University and General Hospital of Vienna, Department of Medicine III, Medical University of Vienna, Vienna, Austria – sequence: 8 givenname: Marie E orcidid: 0000-0002-2263-9783 surname: McDonnell fullname: McDonnell, Marie E organization: Brigham and Women's Hospital and Harvard Medical School, Division of Endocrinology Diabetes and Hypertension, Boston, MA, USA – sequence: 9 givenname: M Hassan surname: Murad fullname: Murad, M Hassan organization: Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA – sequence: 10 givenname: Craig surname: Nielsen fullname: Nielsen, Craig organization: Cleveland Clinic, Cleveland, OH, USA – sequence: 11 givenname: Claire surname: Pegg fullname: Pegg, Claire organization: Diabetes Patient Advocacy Coalition, Tampa, FL, USA – sequence: 12 givenname: Robert J orcidid: 0000-0001-7502-9092 surname: Rushakoff fullname: Rushakoff, Robert J organization: University of California, San Francisco, Department of Medicine, Division of Endocrinology and Metabolism, San Francisco, CA, USA – sequence: 13 givenname: Nancy surname: Santesso fullname: Santesso, Nancy organization: McMaster University, Hamilton, Ontario, Canada – sequence: 14 givenname: Guillermo E surname: Umpierrez fullname: Umpierrez, Guillermo E organization: Emory University, School of Medicine, Diabetes & Endocrinology, Atlanta, GA, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35690958$$D View this record in MEDLINE/PubMed |
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| Copyright | The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. |
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| References | 35870477 - Lancet Diabetes Endocrinol. 2022 Sep;10(9):614-616 35962778 - J Clin Endocrinol Metab. 2022 Sep 28;107(10):e4276-e4277 35962775 - J Clin Endocrinol Metab. 2022 Sep 28;107(10):e4272-e4273 |
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| Title | Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline |
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