Hyperosmolar hyperglycaemic state: A systematic review of management guidelines and their evidence
Authors' conclusion
These guidelines are consensus-based rather than evidence-based because no randomised controlled trials exist. Further research specific to HHS is required to standardise diagnosis and optimise management.
Study context
- Population
- International guidelines on hyperosmolar hyperglycaemic state (HHS) management; MEDLINE, Embase and Emcare searchedof 363 papers identified
- Participants
- 7 participants
- Comparison
- International HHS management guidelines and their evidence base
- Outcome
- Guideline recommendations for HHS
Pooled result
As reported in the abstract
- Diagnostic criteria, ADA and DC: glucose ≥33.3 mmol/L and osmolality ≥320 mOsm/kg
- Diagnostic criteria, JBDS: glucose ≥30.0 mmol/L with osmolality ≥320 mOsm/kg
- Osmolality correction, ADA and DC: <3 mOsm/kg/h; JBDS accepts change of 3-8 mOsm/kg/h
- Fluids, ADA: 0.9% normal saline at 15-20 mL/kg/h or 1-1.5 L/h; JBDS: replace ≈50% of estimated fluid loss within first 12 h
- Insulin, ADA and DC: fixed rate infusion 0.1 units/kg/h; JBDS: 0.05 units/kg/h, increasing by 1.0 units/h as required
Original publication
Hyperosmolar hyperglycaemic state: A systematic review of management guidelines and their evidence. Diabet Med. Published 26 January 2026. doi:10.
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