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  • Review Article
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Advances in the management of hyperglycaemia and diabetes mellitus during hospitalization

Nature Reviews Endocrinology (2025)Cite this article

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This article has been updated

Abstract

Diabetes mellitus, which affects over 537 million people worldwide, considerably increases the risk of emergency room visits and admissions to hospital. Inpatient hyperglycaemia in patients with or without diabetes mellitus is associated with higher rates of complications, extended hospital stays and increased mortality when compared with patients with normoglycaemia. The American Diabetes Association recommends a target range of 5.6–10.0 mmol/l (100–180 mg/dl) for levels of glucose in the blood of patients in intensive care units (ICUs), as well as in general medicine and surgery. Insulin therapy remains the cornerstone of managing inpatient hyperglycaemia, with intravenous insulin preferred in ICU and basal–bolus regimens favoured in non-ICU settings. While bedside capillary blood glucose monitoring is standard for adjusting insulin doses, continuous glucose monitoring provides a more comprehensive glycaemic assessment and enhances the prevention of hypoglycaemia in high-risk hospitalized patients. This Review outlines the latest evidence in managing diabetes mellitus and hyperglycaemia within hospitals.

Key points

  • Dysglycaemia is common in intensive care unit (ICU) and non-ICU settings; both hyperglycaemia and hypoglycaemia are associated with poor outcomes.

  • Glycaemic targets vary according to hospital settings, but maintaining tight control (5.6–10.0 mmol/l (100–180 mg/dl)) of blood levels of glucose in general wards and less strict control (<10 mmol/l (180 mg/dl)) in ICU settings is recommended.

  • In the ICU setting, a variable rate intravenous insulin infusion is the preferred approach to achieve and maintain glycaemic targets.

  • Glucose management in general wards can be achieved using basal–bolus or basal-plus insulin regimens, or by oral anti-diabetes medications.

  • It is important that the transition from intravenous insulin infusion to a scheduled subcutaneous insulin regimen is effectively managed to prevent rebound hyperglycaemia.

  • Continuous glucose monitoring in hospitals provides accurate readings and has the potential to enhance glycaemic metrics.

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Fig. 1: Perioperative algorithm.
Fig. 2: Basal-plus and basal–bolus insulin regimens for the management of general medicine and surgery patients with type 2 diabetes mellitus.
Fig. 3: The use of advanced technology for managing diabetes mellitus in the hospital setting.

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Change history

  • 13 August 2025

    In the version of the article initially published, in Table 1, in the “AACE–ADA” row, both instances of “target glucose level of 7.8–10.0 mmol/l (100–180 mg/dl)” should have read “target glucose level of 7.8–10.0 mmol/l (140–180 mg/dl)” and have now been corrected in the HTML and PDF versions of the article.

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Acknowledgements

G.E.U. acknowledges the support of research grants from the US National Institutes of Health (NATS UL 3UL1TR002378-05S2), from the Clinical and Translational Science Award Program and the NIH and National Center for Research Resources (NIH/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 2P30DK111024-06).

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Authors and Affiliations

  1. Department of Medicine, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA

    Thaer Idrees, Iris Castro-Revoredo, Lucas Hernandez & Guillermo E. Umpierrez

  2. Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

    Ketan K. Dhatariya

  3. Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK

    Ketan K. Dhatariya

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  1. Thaer Idrees
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  2. Iris Castro-Revoredo
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Contributions

T.I., I.C.-R., K.K.D. and G.E.U. researched data for the article, contributed substantially to discussion of the content and wrote the article. T.I., K.K.D., L.H. and G.E.U. reviewed and/or edited the manuscript before submission.

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Correspondence to Thaer Idrees or Guillermo E. Umpierrez.

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Competing interests

T.I. has received research support (paid to Emory University) from AbbVie. G.E.U. has received research support (paid to Emory University) from Bayer, Abbott, Dexcom and Corcept, and has served as a member of advisory boards for Dexcom, Mankind, Glucotrack, Corcept and GlyCare. K.K.D. has received honoraria for travel, advisory boards and speaker fees from Abbott Diabetes, AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Eli Lilly, Menarini and Sanofi Diabetes. I.C.-R. and L.H. declare no competing interests.

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Nature Reviews Endocrinology thanks Mikkel B. Christensen, who co-reviewed with Iben Rix; Peter Lommer Kristensen; and Mervyn Kyi for their contribution to the peer review of this work.

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Idrees, T., Castro-Revoredo, I., Dhatariya, K.K. et al. Advances in the management of hyperglycaemia and diabetes mellitus during hospitalization. Nat Rev Endocrinol (2025). https://doi.org/10.1038/s41574-025-01157-1

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