Management of Hyperglycemia in Hospitalized, Non-Critically Ill Adults

This clinical decision feature explores the management of hyperglycemia in a hospitalized 72 year old woman with type 2 diabetes and pneumonia. Two expert perspectives are presented: one advocates continuing metformin due to its safety and glycemic benefits in stable patients with normal kidney function, while the other recommends switching to insulin for greater flexibility and avoidance of potential risks like lactic acidosis. The debate highlights the lack of consensus on inpatient glycemic management, emphasizing individualized care based on clinical stability, kidney function, and nutritional intake.

This clinical decision feature explores the management of hyperglycemia in a hospitalized 72 year old woman with type 2 diabetes and pneumonia. Two expert perspectives are presented: one advocates continuing metformin due to its safety and glycemic benefits in stable patients with normal kidney function, while the other recommends switching to insulin for greater flexibility and avoidance of potential risks like lactic acidosis. The debate highlights the lack of consensus on inpatient glycemic management, emphasizing individualized care based on clinical stability, kidney function, and nutritional intake.