{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T05:55:42Z","timestamp":1781330142267,"version":"3.54.1"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hyperosmolar hyperglycaemic state (HHS) is an endocrine emergency associated with increased morbidity and mortality. HHS management is largely varied in clinical practice due to a lack of high\u2010quality evidence. This systematic review aims to compare international guidelines and their underlying evidence base in HHS management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Searching MEDLINE, Embase and Emcare databases and reviewing references of relevant papers identified 363 papers, of which seven met the inclusion criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The features of HHS include hypovolaemia, hyperglycaemia and hyperosmolality, but criteria for diagnosis vary from glucose \u226533.3\u2009mmol\/L and osmolality \u2265320\u2009mOsm\/kg (American Diabetes Association [ADA] and Diabetes Canada [DC]) to glucose \u226530.0\u2009mmol\/L with osmolality \u2265320\u2009mOsm\/kg (Joint British Diabetes Society [JBDS]). The ADA and DC guidelines recommend correction of serum osmolality &lt;3\u2009mOsm\/kg\/h, whereas the JBDS accepts an osmolality change of 3\u20138\u2009mOsm\/kg\/h. ADA guidelines suggest 0.9% normal saline at 15\u201320\u2009mL\/kg\/h or 1\u20131.5\u2009L\/h, whereas JBDS guidelines suggest replacing ~50% of the estimated fluid loss within the first 12\u2009h. The ADA and DC guidelines recommend a fixed rate insulin infusion of 0.1\u2009units\/kg\/h. The JBDS guidelines recommend 0.05\u2009units\/kg\/h, increasing by 1.0\u2009units\/h as required.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These guidelines are consensus\u2010based rather than evidence\u2010based because no randomised controlled trials exist. Further research specific to HHS is required to standardise diagnosis and optimise management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70226","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T18:14:18Z","timestamp":1769451258000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hyperosmolar hyperglycaemic state: A systematic review of management guidelines and their evidence"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4331-0706","authenticated-orcid":false,"given":"Rose","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Endocrinology Austin Health  Heidelberg Victoria Australia"},{"name":"Department of Endocrinology Bendigo Health  Bendigo Victoria 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