Abstract:
Inpatient hyperglycemia is a prevalent and clinically significant issue affecting patients with and without preexisting diabetes and is associated with increased infection rates, prolonged hospital stays, higher mortality, and greater healthcare costs. Traditional measures such as mean glucose fail to capture glycemic variability and short-term fluctuations that influence outcomes. Time in range (TIR), defined as the percentage of glucose values between 70–180 mg/dL, has emerged as a more clinically meaningful metric, demonstrating associations with reduced hypoglycemia, improved metabolic stability, and lower rates of complications such as acute kidney injury, wound infections, and mortality. As hospital populations grow more complex, identifying effective inpatient strategies to optimize TIR is increasingly important. This literature review employed a structured search of PubMed, Embase, and Web of Science through December 2025 to identify peer-reviewed studies evaluating inpatient interventions aimed at improving TIR in adults with type 1 or type 2 diabetes. Included studies involved adult inpatients in general wards or intensive care units and encompassed randomized controlled trials, cohort studies, quality improvement initiatives, and technology-based investigations. Pediatric and outpatient-only studies were excluded. Two reviewers independently screened studies and extracted data on patient populations, care settings, insulin strategies, monitoring methods, workflow interventions, and glycemic outcomes. Due to heterogeneity across study designs and interventions, findings were synthesized narratively and organized by intervention category.
Expected results suggest that structured basal–bolus insulin protocols, use of continuous glucose monitoring, clinical decision support tools, and multidisciplinary diabetes care models consistently improve TIR while reducing hypoglycemia and glycemic variability. Evidence indicates that technology-assisted monitoring and team-based approaches may offer the greatest benefit in complex inpatient settings, though effectiveness varies by care environment and patient population. The expected conclusion is that TIR is a superior metric for inpatient glycemic quality and should be more widely adopted in hospital practice. Implementing standardized insulin protocols, integrating glucose monitoring technologies, and supporting multidisciplinary workflows can meaningfully improve glycemic outcomes. However, further high-quality studies are needed to define optimal strategies across diverse inpatient settings and to guide scalable, system-level implementation.
