Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline

Blood Glucose
Blood Glucose Self-Monitoring
Diabetes Mellitus* / drug therapy
Humans
Hyperglycemia* / drug therapy
Hypoglycemic Agents
Insulin
Systematic Reviews as Topic

Dec-21

This guideline was developed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology (128). A detailed description of the Endocrine Society guideline development program can be found online at https://www.endocrine.org/clinical-practice-guidelines/methodology. This methodology includes the use of EtD frameworks to ensure all important criteria are considered when making recommendations (129, 130). The process was facilitated by the GRADEpro Guideline Development Tool (GRADEpro GDT) (131). The GDP consisted of 11 content experts representing the following specialties: endocrinology, internal medicine, primary care, nursing, pharmacy, and diabetes education. A patient representative was also included on the panel. Members were identified by the Endocrine Society Board of Directors and the Clinical Guidelines Committee (CGC) and were vetted according to the conflict-of-interest policy (132), which was adhered to throughout the guideline process to manage and mitigate conflicts of interest. Detailed disclosures of panel members and the management strategies implemented during the development process can be found in Appendix A. In addition, the group included a clinical practice guideline methodologist from the Mayo Evidence-Based Practice Center, who led the team that conducted the systematic reviews and meta-analyses, and a methodologist from the McMaster University GRADE Centre, who advised on methodology and moderated the application of the EtD framework and development of the recommendations.

Two GDP members were assigned to lead each guideline question. The questions addressed in this guideline were prioritized from an extensive list of potential questions through a survey and discussion; 10 questions were identified as most important. The Mayo Evidence-Based Practice Center conducted a systematic review for each question and produced GRADE evidence profiles that summarized the body of evidence for each question and the certainty of the evidence (11). The systematic searches for evidence were conducted on July 2020 and updated in December 2021. In parallel to the development of the evidence summaries, the GDP members searched for and summarized research evidence for other EtD criteria, such as patients’ values and preferences, feasibility, acceptability, costs/resource use, cost-effectiveness, and health equity. Research evidence summaries noted in the EtD frameworks were compiled using standardized terminology templates for clarity and consistency (133). During a series of video conferences, the GDP judged the balance of benefits and harms, in addition to the other EtD criteria, to determine the direction and strength of the recommendation (Table 4 and 5) (133-136).

Maureen Corrigan, [email protected]