Glycemic Control in Hospitalized Patients With Diabetes Mellitus: Case Series and Literature Review to Reduce Inpatient Hyperglycemia With or Without Diabetic Ketoacidosis

Effective inpatient glycemic control is essential to prevent complications such as diabetic ketoacidosis, a serious but avoidable condition linked to longer hospital stays, higher costs, and increased mortality. This review analyzes six preventable cases of diabetic ketoacidosis at a community hospital from April 2022 to October 2023. Such cases often result from inadequate insulin dosing, delayed recognition of hyperglycemia, and inconsistent monitoring. It underscores the role of quality improvement strategies — such as standardized insulin protocols, staff education, and regular feedback — that have been shown to reduce rates of diabetic ketoacidosis by up to 57%. The review advocates for implementing electronic glucose management systems and promoting multidisciplinary collaboration to optimize inpatient diabetes care. Although challenges such as staff compliance and the costs of continuous glucose monitoring exist, these can be addressed through leadership support and targeted interventions. Enhancing protocols and education can significantly lower the incidence of diabetic ketoacidosis and improve outcomes for hospitalized patients with diabetes.