The recent Centers for Medicare & Medicaid Services (CMS) mandate to report hospital harm measures for hypoglycemia and hyperglycemia may represent a critical step in improving inpatient diabetes care. 1 However, this initiative must be approached with a balanced strategy to avoid unintended consequences. This letter outlines the importance of comprehensive glycemia management, the risks of focusing on a single measure, and the need for hospital readiness to implement these changes effectively.
Diabetes mellitus affects approximately 1 in 10 individuals in the United States, leading to more than 17 million emergency department visits and 8 million hospital admissions annually. 2 Insulin is the cornerstone of hyperglycemia treatment of hospitalized patients, but incorrect dosing can result in hypoglycemia, while hyperglycemia remains undertreated in many cases. Poor glycemic management is associated with increased hospital complications, infections, length of stay, readmission rates, and mortality. 3
Recognizing these issues, CMS added severe hypoglycemia (blood glucose <40 mg/dL) and hyperglycemia (blood glucose >300 mg/dL) to the list of electronic clinical quality measures (eCQMs) in August 2021. 4 Beginning in fiscal year 2026 (October 1, 2025 to September 30, 2026), hospitals will be required to report these measures or face a reduction in Medicare reimbursement in fiscal year 2028. 1 This mandate will necessitate the reporting of data for all four calendar quarters. 1
While this mandate promotes transparency and accountability, it also poses challenges. Hospitals currently can choose to track none, one, or both measures, but tracking only hypoglycemia might reduce insulin use, increasing hyperglycemia. 5 Conversely, tracking only hyperglycemia could lead to aggressive insulin use, raising hypoglycemia risk. Both measures must be monitored together to drive meaningful improvements.
The implementation of eCQMs allows hospitals to access actionable data regularly, promoting continuous improvement in glycemia management. However, this may increase the burden on health care systems for data collection and analysis.1,4 Despite this challenge, hospitals should establish glycemic committees, secure executive support, and develop evidence-based policies to meet these new standards.
Capturing only extreme glycemic values does present a limitation as mild hypoglycemia and hyperglycemia are also important. However, hospitals should embrace the opportunity to improve glycemic management by measuring these and other metrics, aiming for continuous improvement. 4
In summary, the CMS mandate for reporting hypoglycemia and hyperglycemia measures starting in 2026 is a vital step toward improving glycemia management in hospitals, though only time will tell if it leads to better outcomes. We believe hospitals must act now, balancing their approach to avoid unintended consequences while preparing to meet these new challenges.
Footnotes
Abbreviations: CMS, Centers for Medicare & Medicaid Services; eCQMs, electronic clinical quality measures.
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MZ reports consulting for Dexcom, Inc. JM is an employee of Glytec, LLC. APD reports research grant support from Dexcom, Inc.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
ORCID iDs: Mihail Zilbermint 
https://orcid.org/0000-0003-4047-7260
Jordan Messler
https://orcid.org/0000-0002-3080-6940
Camille Frances Stanback
https://orcid.org/0009-0000-2234-5593
Kristen Kulasa
https://orcid.org/0000-0002-3559-5046
Andrew P. Demidowich
https://orcid.org/0000-0002-5925-1117
References
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