Optimizing Inpatient Diabetes Management: A Review of Modern Insulin Therapy

Managing diabetes mellitus in hospitalized patients is critical for preventing complications and improving recovery. Poor glycemic control can lead to adverse outcomes such as infections, delayed wound healing, and increased mortality. This comprehensive review synthesizes current evidence and best practices for insulin therapy as the cornerstone of inpatient diabetes management, highlighting its versatility and safety profile.

The review affirms that insulin remains a safe, effective, and versatile therapeutic agent for managing diabetes in the inpatient setting, adaptable to a wide range of patient needs and clinical presentations. Evidence strongly supports the implementation of basal-bolus insulin regimens for most hospitalized patients with diabetes, demonstrating superior glycemic control compared to sliding-scale insulin alone, often leading to a reduction in hyperglycemia episodes by 30-50%. For patients with minimal oral intake or those with type 2 diabetes on a stable diet, basal-only insulin therapy, sometimes combined with correctional insulin, is shown to be effective, maintaining blood glucose within target ranges for over 70% of the day. > The authors emphasize that systematic dose titration, carefully considering individual patient factors, is paramount for achieving glycemic targets while minimizing the risk of hypoglycemia, a critical inpatient complication that can increase hospital stay by 2.5 days on average. The appropriate selection of insulin formulation and regimen, tailored to patient characteristics and nutritional status, significantly contributes to improved patient outcomes and reduced complications.