Management of hyperglycemia in diabetes
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Patient-Centered Approach to Hyperglycemia Management in Diabetes
Recent guidelines emphasize a patient-centered approach for managing hyperglycemia in diabetes, especially type 2 diabetes. This means treatment plans should be tailored to each individual, considering their preferences, comorbidities, and risk factors. Shared decision-making between patients and healthcare providers is key to achieving optimal outcomes 1234.
Lifestyle Modifications and Comprehensive Risk Reduction
Lifestyle changes, such as healthy eating, increased physical activity, and weight management, are foundational in hyperglycemia management. These interventions should be part of a broader strategy that also addresses cardiovascular risk factors, including blood pressure and lipid control, smoking cessation, and, when appropriate, antiplatelet therapy 123.
Pharmacologic Therapy: Individualization and Newer Agents
The choice of glucose-lowering medications should be individualized. Recent evidence supports the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, especially for patients at high risk of cardiovascular or kidney disease. These agents provide cardiorenal protection and their use is recommended regardless of baseline HbA1c or individualized HbA1c targets 2356. For patients without established cardiovascular disease but with high-risk indicators, GLP-1 receptor agonists may also be considered 56.
Glycemic Targets and Monitoring
Glycemic targets should be individualized based on patient characteristics, comorbidities, and risk of hypoglycemia. Most guidelines recommend an upper inpatient blood glucose target of 180 mg/dL, with some variation in lower limits 7810. Regular blood glucose monitoring is essential, and capillary blood glucose testing is standard, though continuous glucose monitoring is gaining support in some settings 78.
Inpatient Hyperglycemia Management
For hospitalized patients, especially in non-critical care settings, basal-bolus insulin regimens are preferred over sliding scale insulin, which is generally discouraged. Guidelines recommend scheduled insulin therapy, with adjustments for nutritional intake and stressors such as glucocorticoid therapy 78910. There is less consensus on the use of oral diabetes medications in the hospital, and guidance on transitioning to home medications at discharge is limited 78.
Special Considerations: Steroid-Induced Hyperglycemia
Steroid (glucocorticoid) therapy can worsen glycemic control or induce new-onset diabetes. Active monitoring and temporary intensification of glycemic management are recommended for patients receiving steroids, whether or not they have pre-existing diabetes .
Holistic and Personalized Care
A holistic approach includes attention to social determinants of health, healthcare system factors, and patient education. Personalized care may involve trial-and-error with medications to achieve targets, and future advances may allow for more precise prediction of drug responses 234.
Conclusion
Effective management of hyperglycemia in diabetes requires a patient-centered, individualized approach that combines lifestyle modification, comprehensive risk reduction, and tailored pharmacologic therapy. Newer agents like SGLT2 inhibitors and GLP-1 receptor agonists are recommended for patients at high cardiovascular or kidney risk. In the hospital, basal-bolus insulin regimens are preferred, and special attention is needed for patients on steroids. Ongoing patient education and shared decision-making remain central to successful diabetes care 12345678+2 MORE.
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