Management of diabetes and hyperglycaemia in the hospital

Lancet Diabetes Endocrinol. 2021 Mar;9(3):174-188. doi: 10.1016/S2213-8587(20)30381-8. Epub 2021 Jan 27.


Hyperglycaemia in people with and without diabetes admitted to the hospital is associated with a substantial increase in morbidity, mortality, and health-care costs. Professional societies have recommended insulin therapy as the cornerstone of inpatient pharmacological management. Intravenous insulin therapy is the treatment of choice in the critical care setting. In non-intensive care settings, several insulin protocols have been proposed to manage patients with hyperglycaemia; however, meta-analyses comparing different treatment regimens have not clearly endorsed the benefits of any particular strategy. Clinical guidelines recommend stopping oral antidiabetes drugs during hospitalisation; however, in some countries continuation of oral antidiabetes drugs is commonplace in some patients with type 2 diabetes admitted to hospital, and findings from clinical trials have suggested that non-insulin drugs, alone or in combination with basal insulin, can be used to achieve appropriate glycaemic control in selected populations. Advances in diabetes technology are revolutionising day-to-day diabetes care and work is ongoing to implement these technologies (ie, continuous glucose monitoring, automated insulin delivery) for inpatient care. Additionally, transformations in care have occurred during the COVID-19 pandemic, including the use of remote inpatient diabetes management-research is needed to assess the effects of such adaptations.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Blood Glucose / drug effects
  • Blood Glucose / metabolism
  • COVID-19 / blood
  • COVID-19 / epidemiology
  • COVID-19 / therapy*
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 1 / therapy*
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / therapy*
  • Disease Management*
  • Hospitalization / trends*
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / epidemiology
  • Hyperglycemia / therapy*
  • Hypoglycemic Agents / administration & dosage
  • Insulin / administration & dosage


  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin