There are an increasing number of people with diabetes or high blood sugar hospitalized in Italian hospitals, in surgery departments, as well as in medicine or specialist departments. But it is not always possible to consult a diabetologist to set up an adequate diagnostic-therapeutic procedure.
Yet correctly managing diabetes (or hyperglycemia from stress or other) is essential to ensure the patient the best outcome of treatment and a short hospital stay. In the light of these considerations, the experts of the Italian Society of Internal Medicine (SIMI) have put together a task force of experts from various scientific societies to draw up ad hoc guidelines, a real vademecum for the management of diabetes or hyperglycemia. non-diabetes’ during hospitalization, even by non-specialists in the field.
The guidelines are published on the portal of the National Guidelines System of the Istituto Superiore di Sanità. There are about 4 million Italians who live with diabetes and among these, one in 6 is hospitalized at least once a year. This means that the hospitalization rate of these people is more than double that of the general population (235 per thousand people, against 99 per thousand people) and their stay in hospital is on average 1.5 days longer than the others. But the phenomenon can also be observed from another perspective: 20-25% of patients hospitalized for other pathologies suffer from diabetes and the presence of this condition has a significant impact on the outcomes (in the case of Covid, for example, 30 3% of the deceased had diabetes). However, not all high blood sugar levels found during hospitalization are attributable to ‘diabetes’.
“Among all these hyperglycaemias – explains the professor George Sesti, president of the Italian Society of Internal Medicine, SIMI – there are in fact people with ‘known’ diabetes, cases of ‘first diagnosis’ diabetes (i.e. cases of diabetes diagnosed for the first time during hospitalisation), but also ‘hospitalization-related or stress-related hyperglycaemia’, which often disappears after discharge. Adequate expertise is therefore needed to lead to a correct diagnosis and treatment of these conditions during hospitalization, organizing patient assistance once discharged”.
But the majority of hospitalizations of people with diabetes or hyperglycemia occur outside diabetes care. In the light of all these considerations, therefore, the need arose to draw up an ad hoc guideline for the ‘Management of diabetes or hyperglycemia in adult patients hospitalized in a non-critical clinical setting’ (i.e. outside intensive care or subintensive). An initiative strongly desired and promoted by the Italian Society of Internal Medicine (SIMI), which carried it out together with the Association of Diabetologists (AMD), the Italian Society of Diabetology (SID), the Federation of Internist Hospital Managers Associations (FADOI ), the Italian Society of Gerontology and Geriatrics (SIGG) and the National Association of Medicine Nurses (ANIMO).
“These guidelines – comments Professor Sesti – intended for doctors, nurses, dieticians, educators working in hospitals and patients, recommend carefully evaluating all hospitalized patients, for any pathology, by looking for the possible presence of hyperglycemia at the time of hospitalisation, to reduce the risks deriving from its presence; during hospitalization, especially if it is necessary to start treatment (with insulin or hypoglycemic drugs), it is also recommended to monitor blood glucose with the classic capillary glycemic monitoring or, where possible, using continuous glycemia monitoring systems, paying particular attention to watch out for any episodes of hypoglycemia. In patients with hyperglycemia/diabetes hospitalized and not previously treated with insulin, in the event of severe glycemic decompensation – concludes Professor Sesti – the guidelines recommend starting a basal insulin therapy (with slow and ultra-slow insulin analogues), possibly making use of ‘pens’, as opposed to syringes. Where possible, it is also advisable to have the person with hyperglycemia evaluated by personnel with diabetes expertise and, at the time of discharge, to adopt a structured follow-up plan, referring the patient to a diabetes center”.