A new clinical practice guideline published in the January 2012 issue of the Journal of Clinical Endocrinology and Metabolism is a consensus recommendation from experts in the field of hyperglycaemia (high blood glucose). They carried out a critical review of a large number of research papers to assess the strength and quality of evidence about the diagnosis and treatment of hyperglycaemia in hospital patients who are not in intensive care. Preliminary drafts of the guideline were reviewed and commented on by Endocrine Society members and a number of professional associations including the European Society for Endocrinology which has the UK Society for Endocrinology as an affiliate member.
Studies have shown that about one third of hospital patients on general wards, not exclusively diabetics, have hyperglycaemia. Causes include the physical stress of illness, trauma or surgery, lack of mobility, drugs including steroids like prednisolone, not taking drugs for diabetes and liquid feeding either by a stomach tube or into a vein. Patients with untreated hyperglycaemia have a longer hospital stay, have slower wound healing, get more infections, are more disabled after discharge from hospital and have a higher risk of dying.
The guideline suggests that all patients, whether they are known to have diabetes or not, should have a lab test for blood glucose on admission to hospital. It recommends that those with concentrations greater than 7.8 mmol/L should be monitored for 24 to 48 hours using a bedside glucose meter and should receive treatment with insulin if the raised concentrations persist. If the initial lab measurement is greater than 7.8 mmol/L, glycated haemoglobin (HbA1c) should be measured as well (unless tested in the preceding two or three months) to help identify those with undiagnosed or inadequately treated diabetes. The guideline goes on to give detailed targets for glucose levels and treatment protocols to help attain them.