Test blood sugar in all hospitalized patients

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Hyperglycemia in hospitalized patients is associated with a greater risk for complications, as reported by Umpierrez and colleagues in the March 2002 issue of the Journal of Clinical Endocrinology & Metabolism.

• All patients, independent of a prior diagnosis of diabetes, should undergo blood glucose testing on admission.
• Hyperglycemia is linked to prolonged hospital stay, increased incidence of infections and death in non-critically ill hospitalized patients.
• Hyperglycemia affects 32% to 38% of patients in community hospitals and is not restricted to individuals with a history of diabetes.
• Better blood sugar control is associated with fewer hospital complications in general medicine and surgery patients.
• All diabetics or hyperglycemia (glucose > 140 mg/dL) should have an A1c test, if not tested in last 2 or 3 months.
• For most hospitalized patients with noncritical illness, the pre meal glucose target is less than 140 mg/dL and the target for a random blood glucose level is less than 180 mg/dL.
• Anti diabetic treatment should be re-evaluated when glucose levels drop below 100 mg/dL and should be modified if glucose levels are below 70 mg/dL.
• Go for tighter control of blood sugar in patients not prone to hypoglycemia.
• Opt for a higher target range (200 mg/dL) for patients with terminal illness or limited life expectancy, or who are at high risk for hypoglycemia.
• Patients with diabetes who receive insulin at home should receive a scheduled regimen of subcutaneous insulin during hospitalization.
• To prevent peri operative hyperglycemia, all patients with type 1 diabetes and most patients with type 2 diabetes who undergo surgery, should be treated with intravenous continuous insulin infusion or subcutaneous basal insulin with as-needed bolus insulin.
• All patients with high glucose values (140 mg/dL]) on admission, and all patients receiving enteral or parenteral nutrition, should be monitored with bedside capillary point-of-care glucose testing, independent of diabetes history.
• At least 1 to 2 hours before intravenous continuous insulin infusion is discontinued, all patients with type 1 and type 2 diabetes should be transitioned to scheduled subcutaneous insulin therapy.

(Source: The Clinical Guidelines Subcommittee of The Endocrine Society, American Diabetes Association, the American Heart Association, the American Association of Diabetes Education, the European Society of Endocrinology, and the Society of Hospital Medicine, January 2012 issue of the Journal of Clinical Endocrinology & Metabolism)