Adherence to Guidelines for Inpatient Pharmacologic Management of Type 2 Diabetes in Adults and Glycemic Outcomes

Alkhiari, Resheed; Alzayer, Hussain; Aljazeeri, Jafar; Vanniyasingam, Thuva; Punthakee, Zubin

doi:10.1016/j.jcjd.2017.05.003

Cited by 14 publications

(11 citation statements)

References 18 publications

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“…Knowledge of recommended IGC target values was relatively low overall in our study but did trend towards improvement as residents progressed through training. Consistent with this finding, a recent retrospective study demonstrated that patients admitted to an internal medicine service by a senior resident were more likely to receive guideline-based care than those admitted by a junior trainee (35). Targeted IGC educational interventions initiated at the beginning of residency training could potentially improve guideline adherence, comfort, and knowledge before trainees become senior residents and subsequently attending physicians.…”

Section: Discussionmentioning

confidence: 74%

A Multicenter Study Evaluating Perceptions and Knowledge of Inpatient Glycemic Control Among Resident Physicians: Analyzing Themes to Inform and Improve Care

et al. 2019

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Objective: In this descriptive study, we evaluated perceptions and knowledge of inpatient glycemic control among resident physicians. Methods: We performed this study at four academic medical centers: the University of Mississippi Medical Center, University of Virginia Health System, University of Louisville Health Sciences Center, and Emory University. We designed a questionnaire, and Institutional Review Board approval was granted at each institution prior to study initiation. We then administered the questionnaire to Internal Medicine and Medicine-Pediatric resident physicians. Results: A total of 246 of 438 (56.2%) eligible resident physicians completed the Inpatient Glycemic Control Questionnaire (IGCQ). Most respondents (85.4%) reported feeling comfortable treating and managing inpatient hyperglycemia, and a majority (66.3%) agreed they had received adequate education. Despite self-reported comfort with knowledge, only 51.2% of respondents could identify appropriate glycemic targets in critically ill patients. Only 45.5% correctly identified appropriate inpatient random glycemic target values in noncritically ill patients, and only 34.1% of respondents knew appropriate preprandial glycemic targets in noncritically ill patients. A small majority (54.1%) were able to identify the correct fingerstick glucose value that defines hypoglycemia. System issues were the most commonly cited barrier to successful inpatient glycemic control. Conclusion: Most respondents reported feeling comfortable managing inpatient hyperglycemia but had difficulty identifying appropriate inpatient glycemic target values. Future interventions could utilize the IGCQ as a pre- and postassessment tool and focus on early resident education along with improving system environments to aid in successful inpatient glycemic control. Abbreviations: DM = diabetes mellitus; Emory = Emory University Healthcare; IGC = inpatient glycemic control; IGCQ = Inpatient Glycemic Control Questionnaire; IRB = Institutional Review Board; PGY = postgraduate year; UMMC = University of Mississippi Medical Center; UVA = University of Virginia Health System; UL = University of Louisville Health Sciences Center

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Section: Discussionmentioning

confidence: 74%

A Multicenter Study Evaluating Perceptions and Knowledge of Inpatient Glycemic Control Among Resident Physicians: Analyzing Themes to Inform and Improve Care

et al. 2019

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“…Along the same line, in a study conducted in a US population with diabetes, the compliance of the health professionals to guidelines in insulin prescriptions in IMU wards was 30% even in the presence of computerized protocols 27 . In sharp contrast, a recent Canadian study conducted in a single IMU ward showed a good compliance (80%) to National Guidelines of inpatient diabetes management, which was associated to better glucose control during admission 28 . However, the latter study was monocentric, was conducted in a specialist ward and excluded patients in poor glucose control at admission.…”

Section: Discussionmentioning

confidence: 95%

A performance score of the quality of inpatient diabetes care is a marker of clinical outcomes and suggests a cause‐effect relationship between hypoglycaemia and the risk of in‐hospital mortality

Dei

Aldigeri

Ridolfi

et al. 2020

Diabetes Metabolism Res

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Aims To build a tool to assess the management of inpatients with diabetes mellitus and to investigate its relationship, if any, with clinical outcomes. Materials and methods A total of 678 patients from different settings, Internal Medicine (IMU, n = 255), General Surgery (GSU, n = 230) and Intensive Care (ICU, n = 193) Units, were enrolled. A work‐flow of clinical care of diabetes was created according to guidelines. The workflow was divided into five different domains: (a) initial assessment; (b) glucose monitoring; (c) medical therapy; (d) consultancies; (e) discharge. Each domain was assessed by a performance score (PS), computed as the sum of the scores achieved in a set of indicators of clinical appropriateness, management and patient empowerment. Appropriate glucose goals were included as intermediate phenotypes. Clinical outcomes included: hypoglycaemia, survival rate and clinical conditions at discharge. Results The total PS and those of initial assessment and glucose monitoring were significantly lower in GSU with respect to IMU and ICU (P < .0001). The glucose monitoring PS was associated with lower risk of hypoglycaemia (OR = 0.55; P < .0001), whereas both the PSs of glucose monitoring and medical therapy resulted associated with higher in‐hospital survival only in the IMU ward (OR = 6.67 P = .001 and OR = 2.38 P = .03, respectively). Instrumental variable analysis with the aid of PS of glucose monitoring showed that hypoglycaemia may play a causal role in in‐hospital mortality (P = .04). Conclusions The quality of in‐hospital care of diabetes may affect patient outcomes, including glucose control and the risk of hypoglycaemia, and through the latter it may influence the risk of in‐hospital mortality.

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“…Type 2 diabetes mellitus (T2DM), a common chronic metabolic disease, is mainly characterized by insulin resistance (IR) and it easily leads to a variety of complications, seriously harming the physical health of patients [1][2][3] . In clinical practice, it is advocated to diagnose and treat T2DM as early as possible.…”

Section: Abstract: Type 2 Diabetes Mellitus Insulin Secretion 25-hydroxyvitamin D3 Correlationmentioning

confidence: 99%

Correlation between Serum 25-Hydroxyvitamin D3 and Abnormal Insulin Secretion in Patients with Type 2 Diabetes Mellitus

Hou¹,

Hu²,

Chen³

et al. 2021

ijps

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Chen et al.: 25-Hydroxyvitamin D3 and type 2 diabetes mellitus To investigate the correlation between serum 25-hydroxyvitamin D3 and abnormal insulin secretion in patients with type 2 diabetes mellitus. Eight type 2 diabetes mellitus patients treated from January 2018 to November 2020 (observation group) and another 80 healthy volunteers receiving physical examination in the same period (control group) were included. Fasting venous blood sample was collected to detect serum 25-hydroxyvitamin D3, fasting blood glucose, glycosylated hemoglobin, fasting insulin, insulin resistance index and insulin secretion index. According to insulin secretion index, observation group was divided into normal and abnormal insulin secretion groups and their serum 25-hydroxyvitamin D3, fasting blood glucose, glycosylated hemoglobin, fasting insulin and insulin resistance index were compared. Based on serum 25-hydroxyvitamin D3 level, observation group was divided into serum 25-hydroxyvitamin D3 positive and negative groups and their fasting blood glucose, glycosylated hemoglobin, fasting insulin, insulin resistance index and insulin secretion index were compared. The correlations of serum 25-hydroxyvitamin D3 with fasting blood glucose, glycosylated hemoglobin, fasting insulin, insulin resistance index and insulin secretion index were analyzed. Observation group had lower serum 25-hydroxyvitamin D3 level and insulin secretion index and higher fasting blood glucose, glycosylated hemoglobin, fasting insulin and

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Adherence to Guidelines for Inpatient Pharmacologic Management of Type 2 Diabetes in Adults and Glycemic Outcomes

Cited by 14 publications

References 18 publications

A Multicenter Study Evaluating Perceptions and Knowledge of Inpatient Glycemic Control Among Resident Physicians: Analyzing Themes to Inform and Improve Care

A Multicenter Study Evaluating Perceptions and Knowledge of Inpatient Glycemic Control Among Resident Physicians: Analyzing Themes to Inform and Improve Care

A performance score of the quality of inpatient diabetes care is a marker of clinical outcomes and suggests a cause‐effect relationship between hypoglycaemia and the risk of in‐hospital mortality

Correlation between Serum 25-Hydroxyvitamin D3 and Abnormal Insulin Secretion in Patients with Type 2 Diabetes Mellitus

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