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Feature Article

Hyperglycaemia management in hospital and postdischarge care

Katherine Tonks

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Abstract

Hyperglycaemia in hospital inpatients is common and detrimental, often occurring in those without a prior diagnosis of diabetes, and is usually associated with poorer outcomes. Postdischarge GP screening for diabetes and treatment adjustments for patients with chronically poor glucose control is as crucial to patient outcomes as in-hospital treatments for hyperglycaemia.

Key Points

  • Hyperglycaemia in hospital inpatients is associated with poorer outcomes.
  • At least 7% of hospital inpatients have a glucose level of 11.1 mmol/L or more, and one-third of these patients have no prior diagnosis of diabetes.
  • In-hospital use of intravenous or basal-bolus insulin is the recommended treatment for hyperglycaemia, and use of sliding scale insulin as sole therapy should be avoided. Short-acting ‘supplemental’ insulin may also be prescribed; however, if required then the dose of the patients’ usual diabetes medications should be increased.
  • Although in-hospital glucose targets and mechanisms for improvement remain controversial, there is no controversy over the need for continuing diabetes care or investigation of hyperglycaemia following discharge from hospital.
  • Patients who experience hyperglycaemia in hospital without a prior diagnosis of diabetes represent an opportunity for diabetes to be diagnosed or treatment initiated to prevent progression to frank diabetes. A 75 g oral glucose tolerance test should be performed at six weeks’ postdischarge because about 75% of these patients will have diabetes or impaired glucose tolerance.
  • Good community diabetes management by GPs and community diabetes teams may help to prevent readmission.
  • Excessively tight glycaemic control, which leads to hypoglycaemia, should be avoided both acutely and long term.
  • HbA1c treatment targets need to be individualised, with higher HbA1c targets for patients at risk of hypoglycaemia, including those with type 1 diabetes, aged over 70 years or with a history of coronary artery disease.

    Picture credit: © Life In View/SPL.

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