Nutrition support-focused strategies for glycemic management in hospitalized adults with diabetes: A narrative review.

Diabetes is commonly encountered in hospitalized adult patients. Blood glucose (BG) management in acutely ill hospitalized patients receiving nutrition support therapy with enteral nutrition (EN) or parenteral nutrition (PN) often varies from strategies utilized in stable patients with diabetes in the outpatient setting. Some degree of BG elevation is expected in hospitalized patients due to the acute stress response. However, hyperglycemia should be prevented, if possible, and treated if it occurs, as it has been shown to increase infections, length of stay, and mortality. While a variety of oral and injectable medications are utilized in outpatients who are fed orally, insulin is the primary therapy utilized in hospitalized patients receiving nutrition support therapy. The use of insulin, interruptions in nutrition support therapy, and abrupt changes in clinical status all increase the risk of hypoglycemia, which is associated with increased morbidity and mortality in acutely ill patients. The aim of this review is to discuss application of recent guideline recommendations and offer practical strategies for safe and effective management of hyperglycemia with nutrition support therapy in hospitalized patients with diabetes.