A practical and evidence-based approach to management of inpatient diabetes in non-critically ill patients and special clinical populations

• Inpatient diabetes control in non-ICU patients can improve clinical outcomes.
• Insulin administration is a mainstay of hyperglycemia management in the wards.
• Avoidance of hypoglycemia is important during glycemia management.
• Several diabetes patient groups will require different treatment approach.
• Future glycemia treatment algorithms should allow individualization of therapy.

Inpatient diabetes is a common medical problem encountered in up to 25–30% of hospitalized patients. Several prospective trials showed benefits of structured insulin therapy in managing inpatient hyperglycemia albeit in the expense of high hypoglycemia risk. These approaches, however, remain underutilized in hospital practice. In this review, we discuss clinical applications and limitations of current therapeutic strategies. Considerations for glycemic strategies in special clinical populations are also discussed. We suggest that given the complexity of inpatient glycemic control factors, the “one size fits all” approach should be modified to safe and less complex patient-centered evidence-based treatment strategies without compromising the treatment efficacy.