From the Guidelines
Hyperglycemia management should prioritize a comprehensive approach combining lifestyle modifications and medication therapy, with metformin as the first-line medication and SGLT-2 inhibitors or GLP-1 receptor agonists as preferred second-line options due to their cardiovascular and renal benefits, as supported by recent guidelines 1.
Key Components of Hyperglycemia Management
- Lifestyle modifications, including medical nutrition therapy, physical activity, weight loss, and psychological support, are fundamental aspects of diabetes care 1.
- Medication therapy, starting with metformin at an initial dose of 500mg once or twice daily, gradually increasing to 1000mg twice daily as tolerated, and adding additional agents based on individual factors 1.
- Blood glucose monitoring, with target fasting glucose of 80-130 mg/dL and postprandial levels below 180 mg/dL for most adults, is essential for managing hyperglycemia 1.
- SGLT-2 inhibitors, such as empagliflozin 10-25mg daily, or GLP-1 receptor agonists, such as semaglutide 0.25mg weekly, titrated up to 1mg weekly, are preferred second-line options due to their cardiovascular and renal benefits 1.
Considerations for Specific Patient Populations
- For patients with advanced diabetes, careful management of glycemic control is necessary to avoid rapid reduction in HbA1c, which can cause paradoxical flare-ups of microvascular complications 1.
- For patients with chronic kidney disease, SGLT2 inhibitors may be continued as long as they are well tolerated and kidney replacement therapy is not imminent, and long-acting GLP-1 receptor agonists may be recommended for patients not achieving individualized glycemic targets despite use of metformin and an SGLT2 inhibitor 1.
Importance of Comprehensive Care
- Comprehensive care, including team-based, integrated care focused on risk evaluation and patient empowerment, is essential for providing high-quality care to patients with diabetes and hyperglycemia 1.
- Structured self-management educational programs can empower patients to develop self-management knowledge and skills, improving long-term clinical outcomes and quality of life 1.
From the FDA Drug Label
The management of antidiabetic therapy should be individualized. Ideally, the response to therapy should be evaluated using HbA1c which is a better indicator of long-term glycemic control than FPG alone. The main goal of treating diabetes is to lower your blood sugar to a normal level. High blood sugar can be lowered by diet and exercise, and by certain medicines when necessary.
Hyperglycemia management involves individualized antidiabetic therapy. The goal is to lower blood sugar to a normal level through:
- Diet
- Exercise
- Medicines when necessary It is recommended to evaluate the response to therapy using HbA1c, a better indicator of long-term glycemic control than FPG alone 2. Patients should be treated for a period of time adequate to evaluate change in HbA1c (three months) unless glycemic control deteriorates 2.
From the Research
Hyperglycemia Management Strategies
- Lifestyle modifications, including nutrition therapy and physical activity, can help individuals with diabetes achieve metabolic goals 3
- Monitoring metabolic parameters, such as blood glucose, glycated hemoglobin, lipids, blood pressure, and body weight, is essential to determine the effectiveness of treatment plans 3
Pharmacological Interventions
- Metformin is the first-line treatment for patients with Type 2 diabetes, and additional therapy is dependent on patient-specific factors, including cardiovascular risks and risk of hypoglycemia 4
- Sulfonylureas and DPP-4 inhibitors can be used as second-line therapies, with sulfonylureas being more effective in lowering HbA1c but also associated with a higher risk of hypoglycemia 4
- Combination therapy with DPP-4 inhibitors and pioglitazone can be a useful therapeutic approach in patients with Type 2 diabetes who cannot tolerate metformin or a sulfonylurea 5
Hospital Management of Hyperglycemia
- The Endocrine Society Clinical Practice Guideline provides recommendations for the management of hyperglycemia in hospitalized adult patients in non-critical care settings, including the use of emerging diabetes technologies and insulin regimens 6
- The guideline includes conditional recommendations for the use of noninsulin therapies, preoperative glycemic measures, and diabetes self-management education in the hospital 6
Lifestyle Intervention and Glycemic Control
- Lifestyle interventions, including dietary changes and physical activity, can significantly lower HbA1c levels in patients with Type 2 diabetes 7
- Strategies combining individualized and group-based activities are the most effective in improving glycemic control, particularly when there is a weight loss 7