2014糖尿病指南: 住院治疗Hospital Care (In-Patient)

2014糖尿病指南: 住院治疗Hospital Care (In-Patient)

Diabetes Care

Discharge planning
   • Begin at admission
   • Clear diabetes management instructions provided at discharge

Sole use of sliding scale insulin in inpatient setting discouraged

All patients
   • Clearly document diabetes in medical record
   • Order blood glucose monitoring; results available to healthcare team

Nondiabetic patients receiving therapy associated with high hyperglycemia risk
   • Monitor glucose
   • Consider treating to same targets as patients with known diabetes

Establish hypoglycemia management protocol and create a plan for each patient for treating and
preventing hypoglycemia
   • Document and track all hypoglycemia episodes

Consider A1C test for patients with
   • Diabetes if no test results from prior 2-3 mos
   • Risk factors for undiagnosed diabetes who exhibit hyperglycemia

Patients with hyperglycemia, no prior diabetes
  • Plan for follow-up testing and care documented at discharge

Glycemic Targets

Critically ill patients

Persistent hyperglycemia:
• Initiate insulin starting at ≤180 mg/dL (≤10.0 mmol/L)
• Once insulin started, 140-180 mg/dL (7.8-10.0 mmol/L) recommended glucose range for most patients

More stringent targets may be appropriate for certain patients providing no increased hypoglycemia risk

IV insulin protocol with demonstrated efficacy, safety in achieving targets with no increased hypoglycemia risk

Non-critically ill patients

No clear evidence for specific glucose targets

Insulin-treated: premeal target
More or less stringent targets may be appropriate
   • More stringent: stable patients with previous tight glycemic control
   • Less stringent: severe comorbidities

Preferred method for achieving/maintaining glucose control: scheduled subcutaneous insulin with basal, nutritional, correction components