Management of hyperglycemia
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Patient-Centered Approach to Hyperglycemia Management
Modern guidelines emphasize a patient-centered approach for managing hyperglycemia, especially in type 2 diabetes. This means treatment plans should be individualized, considering each patient’s health status, preferences, and risk factors. Shared decision-making between patients and healthcare providers is crucial to set appropriate glycemic targets and select therapies that best fit the patient’s needs and lifestyle 1249.
Lifestyle Modifications and Comprehensive Risk Reduction
Lifestyle changes, such as healthy eating, regular physical activity, and weight management, are foundational in hyperglycemia management. These interventions not only help control blood glucose but also reduce cardiovascular risk. Comprehensive care should also address other risk factors, including blood pressure, cholesterol, and smoking cessation, to lower the risk of complications 124.
Pharmacologic Therapy: Individualized Selection
A wide range of antihyperglycemic medications is available, and the choice should be tailored to the individual. Metformin is often the first-line therapy, but other agents—such as GLP-1 receptor agonists and SGLT2 inhibitors—are recommended for patients at high risk of cardiovascular or kidney disease, regardless of baseline HbA1c or individualized targets. These medications have shown benefits in reducing major adverse cardiovascular events, heart failure hospitalizations, and progression of chronic kidney disease 234.
For patients with steroid-induced hyperglycemia, options like DPP-4 inhibitors, metformin, and weight-based neutral protamine Hagedorn insulin are considered safe and effective, though clinical data are limited .
Inpatient and Hospital Hyperglycemia Management
In hospitalized adults, regular blood glucose monitoring is essential. Most guidelines recommend a target upper blood glucose limit of 180 mg/dL, with some variation in lower limits. Basal-bolus insulin regimens are preferred over sliding scale insulin, which is generally discouraged. There is less agreement on the use of oral medications in the hospital, and guidance on transitioning to home medications at discharge is limited 678.
For non-critically ill hospitalized patients, recommendations include the use of continuous glucose monitoring and insulin pump therapy when appropriate, as well as tailored insulin regimens for those receiving steroids or enteral nutrition .
Perioperative Hyperglycemia Management
Perioperative hyperglycemia is linked to worse surgical outcomes. Insulin therapy to correct high blood glucose can reduce complications and mortality in surgical patients. However, the trend is toward moderate and individualized glycemic targets to avoid hypoglycemia, rather than strict glucose control .
Special Considerations: Social Determinants and Holistic Care
Recent guidelines highlight the importance of considering social determinants of health, healthcare system factors, and patient behaviors—including sleep and physical activity—in diabetes management. Addressing these factors can improve outcomes and support a holistic approach to care 24.
Conclusion
Effective management of hyperglycemia requires a personalized, patient-centered approach that combines lifestyle changes, individualized pharmacologic therapy, and comprehensive risk reduction. In both outpatient and inpatient settings, regular monitoring and tailored interventions are key. Newer therapies offer additional benefits for patients at high cardiovascular or kidney risk, and special attention should be given to social and behavioral factors that influence diabetes care.
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