A 21-member expert panel convened by the ASHP Foundation identified 10 recommendations for enhancing insulin-use safety across the medication-use process in hospitals. Professional organizations, accrediting bodies, and consumer groups can play a critical role in the translation of these recommendations into practice. Rigorous research studies and program evaluations are needed to study the impact of implementation of these recommendations.

Researchers using EHR-based phenotype definitions should clearly specify the characteristics that comprise the definition, variations of ADA criteria, and how different phenotype definitions and components impact the patient populations retrieved and the intended application. Careful attention to phenotype definitions is critical if the promise of leveraging EHR data to improve individual and population health is to be fulfilled.

According to the American Diabetes Association (ADA), a basal bolus plus correction insulin regimen is the preferred treatment for non-critically ill patients with good nutritional intake, and use of sliding scale insulin alone is strongly discouraged. 1 Current guidelines for inpatient glycemic control recommend a goal of 140-180 mg/dl in the intensive care unit (ICU), with an acceptable range of 110-140 mg/dl in selected populations, and a preprandial goal of 140 mg/dl for those inpatients that are not critically ill. 1,2 All guidelines agree that maximal inpatient glucose goals should remain below 180 mg/dl. 1-3 Previous studies have demonstrated safe and effective basal bolus strategies with typically 50% of total daily required insulin dose as basal/long acting insulin, and remainder as rapid/short acting insulin with meals and/or as supplemental scale. 4,5 The ability to demonstrate acceptable 664746D STXXX10.

CommentaryEach year people with diabetes account for millions of inpatient days. Many of those patients are on insulin therapy having successfully managed their diabetes in the outpatient setting. Once admitted to the hospital, most have their diabetes care taken over by the admitting team. Patients' knowledge of their diabetes care may be ignored or not assessed. Outpatient physiologic insulin regimens are often replaced with sliding scale insulin given only when blood glucoses are elevated. This has lead well-controlled patients to experience diabetic ketoacidosis or hyperglycemic crisis. 1One particular challenge in the inpatient setting is coordinating blood glucose monitoring, ingestion of food, and insulin administration. Blood glucose monitoring is usually at set times: before meals, at bedtime, and sometimes during the night. Unlicensed assistive personnel or nurses may do this monitoring. Hospital meals may be scheduled at specific times or available as food on demand. Insulin is given by the nurse caring for the patient (or a medication nurse) based on an ordered time. Ideally, blood glucoses should be checked no more than 30 minutes before meals. Rapid-acting insulin should be given 10-15 minutes before the meal and no more than 20 minutes after the first bite of the meal. Although critical to optimizing blood glucose control, the coordination of these activities among 3 different health care team members can be difficult to achieve. In the best situation the activities may be well planned and coordinated; however, hospital nurses can testify to how the best made plans can be quickly derailed by emergent situations. For patients effectively managing their meal-time insulin at home, the lack of coordination can be a particularly frustrating and sometimes a frightening experience, should it ultimately result in profound hypo-or hyperglycemia.Current guidelines from the American Association of Clinical Endocrinologist (AACE), the American Diabetes Association (ADA), and the Endocrine Society are to administer basal, bolus, and correction insulin therapy in the hospital based on the physiologic needs of the patient. 2,3Though this is most often managed by the primary team, the Joint Commission and ADA recommend that patients who are able, be allowed to self-manage their diabetes while hospitalized. 4,5 The American Society of Healthsystem Pharmacists provides some general guidelines from literature reviews. AbstractPatients should be allowed to manage their diabetes in the hospital. Diabetes mellitus is a common and sometimes difficult to control medical issue in hospitalized patients. Oftentimes patients who have been controlling their diabetes well as an outpatient are not allowed to continue this management on the inpatient setting, which can lead to hypo-and hyperglycemia. Involving the patient in his or her diabetes care, including self-management in select patients, may provide a safe and effective way of improving glycemic control and patient satisfaction. This may particularly benefit the dosing ...

Managing diabetes can be a daunting task for patients with cancer. Empowerment-based diabetes education and motivational interviewing are complementary approaches. Oncology nurses may feel unprepared to teach patients and their families about self-care for diabetes, but they provide individualized information on symptom management of cancer throughout hospitalization and at discharge. The essential self-care issues include food, exercise, medication, blood glucose monitoring, prevention, recognition and treatment of hypoglycemia and hyperglycemia, and when and how to get additional medical and educational support. This patient-centered model of diabetes education differs from the older "compliance" model that covers many universal rules for all patients, which are predetermined by the nurse. Informing nurses about their role in care of patients with cancer and diabetes is critical.The incidence of diabetes in the United States continues to rise, with 23.6 million Americans (8% of the population) affected (Centers for Disease Control and Prevention [CDC], 2007). Healthy People 2010 (2000a) has two major goals: increase quality and years of healthy life and eliminate health disparities. The priority focus regarding diabetes is reducing the economic burden and improving quality of life for all people who have or are at risk for diabetes (Healthy People 2010, 2000b. The treatment of diabetes and its accompanying complications are costly, $100 billion annually in the United States and continuing to rise (Garber et al., 2004). Diabetes affects 8%-18% of patients with cancer and can negatively influence the outcomes of treatment (Psarakis, 2006;Singer, 2007). The American Cancer Society ([ACS], 2008) estimates that 1.4 million new cases of cancer will be diagnosed in 2008, and 112,000-252,000 also will have or develop diabetes, making it a significant comorbid condition. Peripheral neuropathies in people with diabetes coupled with chemotherapeutic agents can result in increased toxicities, morbidities, and the potential for treatment discontinuation (Visovsky, Meyer, Roller, & Poppas, 2008).Many patients with cancer have diabetes, usually type 2 or pre-diabetes, at the time of diagnosis and require dual management of the two conditions (Psarakis, 2006). In addition, several chemotherapeutic regimens such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and combinations of steroids can lead to hyperglycemia (Oyer, Shah, & Bettenhausen, 2006 ) recommends an HgA1c less than 7%, which reflects an average blood glucose of less than 170 mg/dl. The closer a patient is to that goal, the less he or she is at risk of developing microvascular complications (ADA). The target goal of less than 170 mg/dl may have to be assessed based on clinical presentation of the patient and existing health problems.Oncology nurses care for patients with chronic diseases, cancer, and diabetes, and educating and supporting patients with diabetes are critical. Most patients with diabetes self-manage the condition through ...