Treatment of hospitalized patient with hyperglycemia: An EFIM critically appraised and adapted guideline

Background: Over the past decade, diabetes mellitus (DM) has emerged as a growing epidemic, with a direct link to an increased risk of hospitalization and a strong effect of glycemic control on clinical outcomes. The aim of this document was to critically appraise and adapt existing clinical practice guidelines (CPGs) to provide specific recommendations for the management of hyperglycemia in hospitalized adults with and without previously known DM, in an attempt to provide a practical tool to reduce the risk of major in-hospital complications. Methods: The first step of the adaptation process was to identify unsolved clinical questions (PICOs) in hospitalized persons with hyperglycemia. This was followed by a critical appraisal of updated existing CPGs and the selection of recommendations that were most applicable to specific clinical situations. Results: From the four updated high-quality evidence-based CPGs, 75 recommendations were selected, focusing on five common clinical scenarios in real-world practice: 1) glycemic targets; 2) persons with comorbidities; 3) elderly adults with low consciousness or dementia with irregular feeding or parenteral/enteral nutrition; 4) special hyperglycemic scenarios (stress hyperglycemia, corticosteroid treatment, fasting); and 5) glucose- lowering therapy at discharge. Of the 75 selected recommendations (59 strong and 16 weak), 37 were based on high-quality evidence, 8 on moderate-quality evidence, and 17 on low-quality evidence, while 13 were based on consensus (best practice statements). The recommendations apply to adults who are hospitalized or discharged from the hospital. Conclusion: Using a systematic methodology, this guideline provides an updated and ease-to-use tool for the management of hospitalized adults with hyperglycemia.