Advances in Inpatient Diabetes Management: Personalization, Technology, and Safety

In his presentation at the American College of Physicians Internal Medicine Meeting 2025 in New Orleans, LA, Rodolfo J. Galindo, MD, FACE, associate professor of medicine at the University of Miami, outlined new developments in the inpatient management of diabetes, emphasizing personalized approaches, updated glycemic targets, and the role of continuous glucose monitoring (CGM) in improving patient outcomes.

Dr Galindo detailed how hyperglycemia is prevalent among hospitalized patients, with rates of 20% to 40% in non-intensive care unit (ICU) settings and up to 40% in ICU settings. The American Diabetes Association (ADA) 2024 Standards of Care recommend a glycemic target of 140–180 mg/dL for most critically ill patients, with more stringent targets (110–140 mg/dL) appropriate for selected individuals if achievable without hypoglycemia. In non-ICU settings, basal-bolus insulin remains the preferred approach over sliding scale insulin, although limitations include hypoglycemia risk and overtreatment in some patients.

Dr Galindo reviewed recent studies, which explored the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 agonists (GLP1a) in the inpatient setting. Empagliflozin and dapagliflozin have shown clinical benefits when initiated during or shortly after hospitalization for acute heart failure, with reduced risk of worsening heart failure and cardiovascular death. However, concerns have been raised regarding GLP1a use in the peri-operative period due to an increased prevalence of residual gastric content and potential post-operative complications, suggesting the need for individualized peri-operative protocols.

The role of CGM technology in the hospital has gained traction, with studies demonstrating improved glycemic management and reduced hypoglycemia in non-ICU settings. Several commercial devices showed high accuracy. Real-time CGM, when used with confirmatory point-of-care glucose monitoring, reduced hypoglycemic events and improved glycemic control in hospitalized patients at high risk for hypoglycemia. The 2024 ADA Standards of Care recommend continuing CGM use in hospitalized patients who already use personal CGM devices, provided appropriate resources and training are available.

However, Dr Galindo noted that clinicians should be mindful of several limitations in inpatient diabetes management. For example, basal-bolus insulin regimens, while preferred over sliding scale insulin, are associated with hypoglycemia and potential overtreatment in non-ICU patients. Additionally, concerns surrounding the peri-operative use of GLP1a therapy highlight the need for pre-operative protocols that consider therapy duration, prior GI side effects, fasting times, and procedure types to mitigate risks of residual gastric content and post-operative complications. Finally, the success of CGM use in hospitalized patients depends on the presence of institutional protocols and adequate provider training to ensure safe and effective implementation.

“Management of hyperglycemia in the inpatient setting has evolved with advances in technology and a more personalized approach to care, offering improved safety and outcomes for patients,” Dr Galindo concluded.

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