Background: The prevalence of diabetes among hospitalized patients is high. One out of 4 hospitalized patients has diabetes; thus, treating hyper- or hypoglycemia represents an everyday challenge in hospitals worldwide. Objective: This study aimed to assess the level of adherence to current American practice guidelines for inpatient pharmacologic management of type 2 diabetes and its effect on glycemic outcomes. Patients and Methods: A prospective study was conducted in Internal Medicine Department, Faculty of Medicine, Zagazig University in the period from April 2020 to April 2021. It included 50 patients with type 2 diabetes who were treated with insulin and/or other antihyperglycemic drugs. They were followed up during their hospital stay for hyperglycemic and hypoglycemic episodes. Results: Mean capillary blood glucose measurement (CBGM) throughout three days were higher among Guideline adherence group than Guideline non-adherence group (12.6±1.04 vs. 5.2±1.3) with statistically significant difference p < 0.0001. In addition, 88.0% of Guideline adherence group CBGM was measured four times or more per day. The incidence of hyperglycemic reading (12.0% in Guideline adherence group and 36.0% in Guideline non- adherence group) showed statistically significant difference p= 0.047. Conclusions: There is a good level of adherence to the current American guidelines for inpatient management of type 2 diabetes. The level of adherence is greater with more training and clinical seniority.