Challenges With Insulin in the Inpatient Setting

Kolanczyk, Denise M.; Dobersztyn, Rachel

doi:10.2337/diaspect.29.3.146

Cited by 6 publications

(2 citation statements)

References 17 publications

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“…Insulin is frequently cited as one of the medicines most commonly associated with medication errors in hospital, and is widely used to treat diabetes within the inpatient setting . As the prevalence of diabetes continues to increase (more than one million people with diabetes were admitted to hospital in England in 2017), along with the range of available insulins in varying concentrations, the challenge of diabetes management in people in hospital persists, with potentially greater scope for insulin errors .…”

Section: Introductionmentioning

confidence: 99%

Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review

2019

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Aim To conduct a systematic review of literature to identify interventions that are effective in improving insulin prescribing for people with diabetes in the hospital setting. Methods Computerized bibliographic databases were searched for studies published in English that described the effectiveness of interventions to improve insulin prescribing within the hospital setting. Studies were eligible for inclusion if they reported data that compared insulin prescribing practice after an intervention or compared with a control group. Studies were not excluded on the basis of publication date, geographical location or risk of bias assessment. Results We identified 35 studies for inclusion in the review, including two cluster randomized controlled trials, two cohort studies, and 31 uncontrolled before–after studies. Studies reported a variety of interventions that aimed to increase insulin prescribing accuracy or completeness or decrease the use of discouraged subcutaneous sliding scale insulin regimens. Differences in definition of insulin prescribing error, terminology and common practice based on geographical location was evident, and quality issues with respect to study design and reporting somewhat limited the interpretation of conclusions. Conclusions Implementing strategies that are sensitive to local context and designed to increase adherence to insulin prescribing guidelines are associated with a reduction in prescribing errors. Future implementation should build on effective approaches including multifaceted interventions involving multiple stakeholders at various institutional levels. Future studies in insulin prescribing errors would benefit from the use of standardized approaches, terminology and outcome measures to enable greater comparison.

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Section: Introductionmentioning

confidence: 99%

Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review

2019

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“…This reactive approach has been found to inadequately take into account the amount of carbohydrate in the meal to be consumed as well as various other patient-specific factors; failing to consider these factors may lead to further episodes of hyperglycemia and hypoglycemia. 10 Additionally, the results of the Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes (RABBIT 2 trial) found basal-bolus insulin therapy to achieve the blood glucose target in 68% of patients compared to 38% in the sliding-scale regular insulin group, further invalidating prior correctional scale-only approach. 11 Finally, a lack of reporting of hypoglycemia occurrences and oversight resulted in the inability for diabetes specialists to track quality metrics and prospectively plan interventions.…”

Section: Hospital-wide Initiativesmentioning

confidence: 99%

Retrospective Quality Improvement Study of Insulin-Induced Hypoglycemia and Implementation of Hospital-Wide Initiatives

Shelton

Demidowich

Motevalli

et al. 2021

J Diabetes Sci Technol

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Background: Hospitalized patients who are receiving antihyperglycemic agents are at increased risk for hypoglycemia. Inpatient hypoglycemia may lead to increased risk for morbidity, mortality, prolonged hospitalization, and readmission within 30 days of discharge, which in turn may lead to increased costs. Hospital-wide initiatives targeting hypoglycemia are known to be beneficial; however, their impact on patient care and economic measures in community nonteaching hospitals are unknown. Methods: This retrospective quality improvement study examined the effects of hospital-wide hypoglycemia initiatives on the rates of insulin-induced hypoglycemia in a community hospital setting from January 1, 2016, until September 30, 2019. The potential cost of care savings has been calculated. Results: Among 49 315 total patient days, 2682 days had an instance of hypoglycemia (5.4%). Mean ± SD hypoglycemic patient days/month was 59.6 ± 16.0. The frequency of hypoglycemia significantly decreased from 7.5% in January 2016 to 3.9% in September 2019 ( P = .001). Patients with type 2 diabetes demonstrated a significant decrease in the frequency of hypoglycemia (7.4%-3.8%; P < .0001), while among patients with type 1 diabetes the frequency trended downwards but did not reach statistical significance (18.5%-18.0%; P = 0.08). Based on the reduction of hypoglycemia rates, the hospital had an estimated cost of care savings of $98 635 during the study period. Conclusions: In a community hospital setting, implementation of hospital-wide initiatives targeting hypoglycemia resulted in a significant and sustainable decrease in the rate of insulin-induced hypoglycemia. These high-leverage risk reduction strategies may be translated into considerable cost savings and could be implemented at other community hospitals.

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Current Recommendations for Insulin Therapy in the Hospitalized Patient

Rochester-Eyeguokan,

Pincus

2024

Critical Care Nursing Clinics of North America

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Challenges With Insulin in the Inpatient Setting

Cited by 6 publications

References 17 publications

Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review

Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review

Retrospective Quality Improvement Study of Insulin-Induced Hypoglycemia and Implementation of Hospital-Wide Initiatives

Current Recommendations for Insulin Therapy in the Hospitalized Patient

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