Management of in-hospital hyperglycemia in non-critical adult patients: therapeutic insulinization schemes and current use of oral hypoglycemic agents – A rapid systematic review

Lizeth Acosta Tascón; David Alexander Vernaza Trujillo; John Jairo Duque Ossman; Laureano Quintero Barrera; Alín Abreu Lomba

Lizeth Acosta Tascón Department of Internal Medicine, Universidad Libre, Cali, Colombia
David Alexander Vernaza Trujillo Department of Public Health, Universidad Javeriana, Clínica Imbanaco, Cali, Colombia
John Jairo Duque Ossman Department of Endocrinology, Universidad del Quindío, Armenia, Colombia
Laureano Quintero Barrera Department of Trauma and Emergency Surgery, Universidad del Valle, Clínica Imbanaco, Cali, Colombia
Alín Abreu Lomba Department of Endocrinology, Universidad Libre, Clínica Imbanaco, Cali, Colombia

Keywords: in-hospital hyperglycemia, diabetes mellitus, insulin therapy, oral hypoglycemic agents, metabolic control

Abstract

In-hospital hyperglycemia, defined as a serum glucose value ≥140 mg/dL, is a common condition that may occur in patients with a pre-existing diagnosis of diabetes mellitus or may develop secondary to stress phenomenon. There is extensive evidence in both critically ill and non-critically ill patients that demonstrates a strong association between hyperglycemia and various adverse clinical outcomes. Insulin therapy is the mainstay of treatment in almost all care settings today. However, new evidence has emerged that the use of certain oral hypoglycemic agents in non-critically ill hospitalized patients has been endorsed in terms of safety and efficacy. The objective of this article is to evaluate the therapeutic schemes currently recommended for the management of in-hospital hyperglycemia in non-critical patients. We conducted a systematic review of randomized clinical trials (RCTs) evaluating the treatment of hospitalized hyperglycemia in non-critically ill patients with insulin therapy and/or oral hypoglycemic agents. PubMed, Google Scholar and Clinical Key/Scopus were searched with the terms MESH, “hospitalized patient”, “insulin”, “hypoglycemic agents”, and “efficacy” between the years 2014 to 2024. Based on the search criteria, 91 studies were identified, of which 27 were prioritized, and once the inclusion criteria were applied, 6 randomized clinical trials were chosen. The articles were selected according to the review’s objectives and the clinical outcomes in efficacy and safety to be evaluated. Insulin therapy remains the best therapeutic option for glycemic control in hospitalized patients who develop hyperglycemia; however, recent evidence has emerged that, in terms of safety and efficacy, supports the use of oral hypoglycemic therapy in certain selected groups.