Diabetes Management in Hospitalized Patients: A Comprehensive Clinical Guide (Contemporary Endocrinology) [1st ed. 2023] 303144647X, 9783031446474

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Contemporary Endocrinology Series Editor: Leonid Poretsky

Rifka C. Schulman-Rosenbaum   Editor

Diabetes Management in Hospitalized Patients A Comprehensive Clinical Guide

Contemporary Endocrinology Series Editor Leonid Poretsky, Division of Endocrinology Lenox Hill Hospital New York, NY, USA

Contemporary Endocrinology offers an array of titles covering clinical as well as bench research topics of interest to practicing endocrinologists and researchers. Topics include obesity management, androgen excess disorders, stem cells in endocrinology, evidence-based endocrinology, diabetes, genomics and endocrinology, as well as others. Series Editor Leonid Poretsky, MD, is Chief of the Division of Endocrinology and Associate Chairman for Research at Lenox Hill Hospital, and Professor of Medicine at Hofstra North Shore-LIJ School of Medicine.

Rifka C. Schulman-Rosenbaum Editor

Diabetes Management in Hospitalized Patients A Comprehensive Clinical Guide

Editor Rifka C. Schulman-Rosenbaum Division of Endocrinology Long Island Jewish Medical Center Northwell Health New Hyde Park, NY, USA

ISSN 2523-3785     ISSN 2523-3793 (electronic) Contemporary Endocrinology ISBN 978-3-031-44647-4    ISBN 978-3-031-44648-1 (eBook) https://doi.org/10.1007/978-3-031-44648-1 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Paper in this product is recyclable.

To my husband (and best friend) Avi, for the endless love, support, and encouragement, and for handling parent duty for all the countless hours of weekend time devoted to this book. Thank you, I could not have done this without you! To my children Rachel, Moshe, and Gabby, for cheering me on and for sharing me with medicine, this book and other endeavors. Rachel— Thank you for twenty years (and counting) of proud mama moments, looking forward to seeing great things from you, my “sister”. Moshe—Your easy going personality is truly appreciated, now time for a screen break. Gabby— You are the family treasure, and future endocrinologist, class of 2044.

Foreword

Diabetes mellitus is arguably the most common diagnosis encountered in hospitalized patients. Although relatively few patients are hospitalized with a primary diagnosis of diabetes, many patients on both medical and surgical services have diabetes as a complicated condition. Admission and readmission rates are significantly increased for patients with diabetes and appropriate management of diabetes in hospitalized patients can improve outcomes and reduce the length of stay. Dr. Rifka C. Schulman-Rosenbaum has assembled an impressive group of experts to address all aspects of diabetes in hospitalized patients. The topics include diabetes management when diabetes is a primary or a secondary diagnosis (for the latter group including a primary diagnosis of COVID-19), nutritional aspects in hospitalized patients with diabetes, perioperative management, diabetes in patients with oncological diagnoses, and multiple other topics spanning 30 chapters. A thorough discussion of diabetes technology as it relates to the hospital setting is also included. This monograph without a doubt will be an extremely useful source of information for physicians in multiple specialties as well as students of medicine at all levels. The editor and the contributors can be proud of their remarkable accomplishment. Department of Medicine, Lenox Hill Hospital New York, NY, USA

Leonid Poretsky,

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Preface

Diabetes mellitus has become increasingly prevalent in the United States and worldwide. In conjunction with the epidemic of obesity, the sheer numbers of patients with diagnosed and undiagnosed type 2 diabetes are straining the healthcare system, including a high prevalence of diabetes patients in the hospital setting. Frequently 25–30% of hospital patients have diabetes, with concomitant hyperglycemia and hypoglycemia which impacts morbidity and mortality. Inpatient diabetes management has become increasingly more complex following the advent of many newer pharmacotherapy options as well as devices including insulin pumps and continuous glucose monitors. Patients often have other comorbidities such as renal impairment or cancer, or require specialized surgery or nutritional approaches, all with important differences when it comes to diabetes care. Furthermore, differentiating the unique types of diabetes mellitus that may be encountered in the inpatient setting is critical, as management differs in some key areas. Because of the high prevalence of diabetes in the hospital, having the ability to properly care for patients requires not only skilled endocrinologists and endocrine fellows but the close involvement of internal medicine hospitalists and other specialty physicians (i.e., emergency department, surgery, obstetrics, critical care), residents, medical students, nurse practitioners, physician assistants, pharmacists, nurses including Certified Diabetes Care and Education Specialists, registered dietitians, and more. Diabetes is encountered in all segments of the hospital; its effects are far reaching. Improving inpatient diabetes management can affect healthcare cost and benefit the hospital both financially and from a quality management standpoint. Discharge planning and diabetes education are also fundamental components of management to ensure a safe transition from inpatient to the outpatient setting and to prevent readmissions. This book is designed to provide practical guidance on diabetes management for hospitalized patients. The number of topics covered is meant to be comprehensive and include discussion on many potential scenarios encountered on the inpatient service, but in a concise and user-friendly manner. I hope that it will be extremely

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useful for both learners (fellows, residents, students) and existing providers looking to improve their knowledge and skills in evidence-based inpatient diabetes management. Importantly, I am indebted to the incredible panel of authors among the 30 enclosed chapters, including many globally renowned physicians, researchers, and clinicians. New Hyde Park, NY, USA

Rifka C. Schulman-Rosenbaum

Acknowledgment

• Dr. Yael Tobi Harris for the idea of editing a book and the ongoing and much appreciated support. • Dr. Jeffrey Mechanick my long-time mentor for the inspiration to juggle high volumes of patients with countless academic pursuits and leadership. • Dr. Tracy Breen for hiring me as an inpatient endocrinologist after fellowship and being an inspiring and accomplished female role model. • My inpatient diabetes team at Long Island Jewish Medical Center for tackling the daily challenges of diabetes care and the pursuit of excellence. • To 12 years of endocrine fellows, I have rounded with day in and day out and provided opportunities of mutual ongoing education. • To my loving parents for cheering me on since childhood and still putting my work on the refrigerator. • To Grammy, you are the best! XOXO

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Contents

Part I Basics of Inpatient Diabetes Management 1

 he History of Inpatient Diabetes������������������������������������������������������������   3 T Danielle Brooks, Rifka C. Schulman-Rosenbaum, Rodolfo Galindo, and Guillermo E. Umpierrez

2

Current Standards of Care for Inpatient Type 2 Diabetes Mellitus��������������������������������������������������������������������������������������������������������  25 Naomi Friedman and Hanna J. Lee

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 valuation and Management of Inpatient Hypoglycemia ��������������������  39 E Paras B. Mehta, Esther Rov-Ikpah, and Robert J. Rushakoff

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I npatient Type 1 Diabetes��������������������������������������������������������������������������  51 Anna Delfina Giannella, Tricia Santos Cavaiola, and Kristen Kulasa

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 iabetes in the Critically Ill Patient: DKA, HHS, and Beyond ������������  65 D Baani Singh, Sylvia Chlebek, and Armand Krikorian

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 se of Non-insulin Agents for Hyperglycemia Management in U Hospitalized Patients ������������������������������������������������������������������������������   77 Yael T. Harris, David M. Reich, and Xiao Qing Li

Part II Diabetes Technology in the Hospital 7

Clinical Practice Update: Inpatient Insulin Pump and Integrated Insulin Delivery Systems��������������������������������������������������������  95 Son Nguyen, Georgia M. Davis, and Madhuri M. Vasudevan

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Continuous Glucose Monitoring in the Hospital Setting: Current Status and Future Directions ���������������������������������������������������� 117 Georgia M. Davis and Madhuri M. Vasudevan

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Computer-Guided Approaches to Inpatient Insulin Management ���������������������������������������������������������������������������������������������� 129 Jagdeesh Ullal and Joseph A. Aloi

10 R  emote Glucose Management for Hospitalized Patients ���������������������� 141 Moon Kyung Choi, Paras B. Mehta, and Robert J. Rushakoff Part III Inpatient Diabetes Management in Unique Populations 11 D  iabetes Management in the Emergency Department�������������������������� 149 Dana Gottlieb, Robert Silverman, and Rifka C. Schulman-Rosenbaum 12 I npatient Glucocorticoid-Induced Hyperglycemia �������������������������������� 165 Elizabeth Paul and Danielle Brooks 13 D  iabetes and COVID-19���������������������������������������������������������������������������� 179 Sara Atiq Khan, Salman Zahoor Bhat, and Mihail Zilbermint 14 O  verview of Inpatient Management of Hypertriglyceridemia Associated Acute Pancreatitis in Patients with Diabetes Mellitus��������� 193 Fuad Benyaminov and Avani Sinha 15 T  ype 3c Diabetes���������������������������������������������������������������������������������������� 207 Marina M. Charitou and Huda Al-Bahadili 16 C  ystic Fibrosis-related Diabetes �������������������������������������������������������������� 217 Ryan Richstein, Trisha Menon, and Janice Wang 17 I npatient Management of Diabetes During Pregnancy�������������������������� 235 Rawann Nassar, David W. Lam, and Nirali A. Shah 18 P  ostpartum Diabetes Management���������������������������������������������������������� 253 Nancy Drobycki and Jessica Abramowitz 19 P  erioperative Management of Blood Glucose in Adults with Diabetes Mellitus ������������������������������������������������������������������������������ 267 Ally W. Wang, Ji Ae Yoon, Niloofar Mirsaidi, and Rifka C. Schulman-Rosenbaum 20 H  yperglycemia and Diabetes in the Posttransplant Patient������������������ 287 Samaneh Dowlatshahi, Maleeha Zahid, and Archana R. Sadhu 21 G  lycemic Management in Coronary Artery Bypass Graft Patients �������������������������������������������������������������������������������������������� 307 Vincent Cascio and Aren Skolnick 22 D  iabetes After Bariatric Surgery�������������������������������������������������������������� 323 Jenny C. Bello-Ramos, Ivania M. Rizo, and Sara M. Alexanian

Contents

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23 I npatient Management of Patients with Diabetes and Kidney Disease������������������������������������������������������������������������������������ 337 Erica Patel, Steve Kim, and Roma Gianchandani 24 D  iabetes Care in the Oncologic Population �������������������������������������������� 355 Lubaina S. Presswala, Azeez Farooki, and James Flory 25 I npatient Management of Children and Adolescents with Diabetes Mellitus���������������������������������������������������������������������������������������� 371 Jennifer Apsan, Jennifer Sarhis, and Benjamin Udoka Nwosu Part IV Inpatient Diabetes and Nutrition 26 D  iabetes and Oral Nutrition for Hospitalized Patients�������������������������� 389 Grace Y. Kim, Minni Shreya Arumugam, Maria Green, and Aidar R. Gosmanov 27 D  iabetes and Enteral Nutrition in the Hospital Setting ������������������������ 397 Salwa Zahalka, Robert J. Rushakoff, and Cecilia C. Low Wang 28 D  iabetes and Parenteral Nutrition ���������������������������������������������������������� 413 Michael A. Via Part V Diabetes Education and Transition to Outpatient 29 I npatient Diabetes Education������������������������������������������������������������������� 429 Ann Marie Hasse, Theresa King, and Tori Calder 30 B  arriers to Diabetes Care at Hospital Discharge������������������������������������ 443 Caitlyn Gordon, Hannah Nelson, and Karina Perez-Vilbon Appendix: Inpatient Diabetes Management Guide���������������������������������������� 461 Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465

Part I

Basics of Inpatient Diabetes Management

Chapter 1

The History of Inpatient Diabetes Danielle Brooks, Rifka C. Schulman-Rosenbaum, Rodolfo Galindo, and Guillermo E. Umpierrez

Introduction Within the timeline of modern medicine, the history of diabetes treatment is comparatively brief, yet monumental. After the discovery of insulin by Banting and Best in 1921, the first successful use of insulin occurred in a 14-year-old patient with diabetic ketoacidosis in 1922. It was not until 1936 that the first modified insulin using animal products derived from cattle and pigs was introduced. The first synthetic, genetically engineered insulin using E. coli was introduced in 1978, while synthetic analog insulins became available in the 1980s, and the newest analogs were introduced in the last 20 years [1–3]. Randomized

D. Brooks (*) · R. C. Schulman-Rosenbaum Division of Endocrinology, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New York, NY, USA e-mail: [email protected]; [email protected] R. Galindo Division of Endocrinology, Department of Medicine, University of Miami Miller School of Medicine, Lennar Medical Center, University of Miami Health System, Jackson Memorial Health System, Miami, FL, USA e-mail: [email protected] G. E. Umpierrez Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 R. C. Schulman-Rosenbaum (ed.), Diabetes Management in Hospitalized Patients, Contemporary Endocrinology, https://doi.org/10.1007/978-3-031-44648-1_1

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controlled trials involving insulin use for diabetes management in the hospital have occurred more recently in the history of medicine. In this chapter, we review the history of inpatient diabetes management as it pertains to the landmark trials, clinical practice guidelines, and evolving models of diabetes care in the hospital setting.

Inpatient Diabetes Epidemiology The prevalence of diabetes mellitus is rising. As of 2022, 11.3% of Americans have diabetes [4]. Of those with diabetes, approximately 77% have a known diagnosis, whereas the remaining cases are undiagnosed. There are 1.4 million new diabetes diagnoses each year [4]. The number of diabetes-related hospitalizations per year has increased significantly since 2000, nearly doubling to greater than 8.2 million hospitalizations in 2018 [5]. The total costs of diabetes care in the United States have matched this rising prevalence, increasing by 26% from 2012 to 2017, to $327 billion annually [6]. Inpatient diabetes accounts for approximately 30% of total costs of diabetes care [6]. Hyperglycemic emergencies are frequently encountered in inpatient medicine. A 2015 observational study revealed that approximately 23% of intensive care unit (ICU) admissions involve patients with diabetes mellitus with 9.3% of patients having had undiagnosed diabetes prior to their hospitalization [7]. Data from 2009 to 2014 shows that the age-adjusted rate of diabetic ketoacidosis (DKA)-related hospitalizations increased by 54.9% to 30.2 per 1000 persons, with an average annual rate of increase at 6.3%; fortunately, inpatient DKA-related mortality rates in the United States have declined over time [8]. In 2018, the rate of DKA-related hospitalizations was more frequent than that of hyperglycemic hyperosmolar syndrome (HHS) [9]. It is well established that hyperglycemia is associated with adverse outcomes including increased hospital mortality and prolonged hospitalizations in patients with and without diabetes [10–13]. Inpatient hyperglycemia management has changed over time to optimize patient care to treat the growing diabetes population and avoid the negative consequences of both hyperglycemia and hypoglycemia [14, 15]. Here, we will review the landmark studies that have served as the foundation of modern-day inpatient diabetes practice. A timeline of these studies is illustrated in Fig. 1.1, and summary of their key findings can be found in Table 1.1 for the critically ill population and Table 1.2 for the noncritically ill population.

1935 High dose insulin DKA protocols

1963 First insulin pump prototype

1971 First glucometer

First blood glucose test strip 1965 1976 Kitabchi et al.21 First RCT of low dose insulin DKA protocol

Alberti et al.20 First successful DKA management with low dose IM insulin 1973 DIGAMI study25 1995 1999 First CGM approved by FDA

2004 2006 Portland Leuven Diabetic Medical Project28 ICU Trial27

GLUCOCABG Trial29 2015 2013 Basal Plus Trial33

RABBIT 2 Surgery Trial32 2011 2009 NICESUGAR Trial14

RABBIT 2 Trial15 2007

2020 COVID-19 Pandemic SC DKA protocols

Retrospective SSI study of non-ICU T2DM patients34 2021

Fig. 1.1  Timeline of landmark inpatient diabetes studies and historical diabetes milestones. DKA diabetic ketoacidosis, IM intramuscular, RCT randomized controlled trial, CGM continuous glucose monitor, FDA U.S. Food and Drug Administration, SICU surgical intensive care unit, SC subcutaneous, SSI sliding-­ scale insulin, T2DM type 2 diabetes mellitus

Discovery of insulin 1921

Smith et al.19 First low dose insulin DKA protocol 1954

Van den Berghe et al.26 Mortality in Umpierrez et al. SICU in intensive vs. SC insulin conventional lispro DKA insulin therapy protocol22 2001 2004

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Table 1.1  Summary of landmark inpatient diabetes studies in critically ill patients (ICU) First author (year) Study design Study population Alberti Observational N = 14 (1973) [16] DKA patients

Kitabchi RCT (1976) [17]

N = 48 DKA patients

Primary objective To describe a new regimen for diabetic coma using low-dose IM regular insulin

Intervention Low-dose protocol: initial mean insulin dose: 16 ± 2 units, then 5–10 units IV or IM hourly To compare High-dose low-dose IM protocol: >10 insulin to units IV insulin high-dose IV + 30 units of and SC insulin SC insulin (if in DKA BG 300– 399 mg/dL), increased up to IV 50 units with 100 units SC (if BG >1000 mg/dL). Both groups were followed by 50 units/h of SC insulin Low-dose protocol: 0.1 unit/lb body weight IM insulin followed by 5 units/h IM insulin

Key findings Low-dose IM insulin is effective in DKA treatment

Less insulin was needed to correct BG to 215 mg/ dL When the patient was discharged from the ICU, BG was maintained at 180–200 mg/ dL for both groups SC group: SC insulin lispro 0.3 units/kg and then 0.1 units/kg/h until BG was 240 mg/dL) compared to BBI or basal-plus There was no difference in hypoglycemia between BBI and basal-plus regimens

For continuous SSI patients: 96% of patients with admission BG