Collaboration of Hospital Pharmacists and Hospitalists to Address Glycemic Control of General Medicine Patients: Implementation of a Pilot Inpatient Diabetes Management Program

Ketz, Jeffrey M.; Yeh, Eric; Suri, Sanjeev

doi:10.2337/cd19-0003

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…In a diabetes stewardship program, pharmacists are actively involved in glycemic management, including daily BG assessment and insulin dose adjustment. Through close monitoring of BG and adjustment of insulin dose on an as-needed basis, diabetic stewardship can improve patient outcomes and increase the use of guideline-recommended insulin regimens [ 7 ]. Pharmacist-led diabetes management may also lead to increased physician satisfaction with glycemic management, allowing them to focus on treating the acute active illness.…”

Section: Discussionmentioning

confidence: 99%

“…can affect blood glucose (BG) levels. Multiple studies of pharmacy-led inpatient hyperglycemic management have demonstrated success in improving patient outcomes [4][5][6][7][8]. However, most hospitals do not have a designated team (i.e., diabetes stewardship) to assess and adjust insulin regimens (e.g., sliding scale intensity, dose, etc.…”

Section: Introductionmentioning

confidence: 99%

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Real-world community hospital hyperglycemia management in noncritically ill, type 2 diabetic patients: a comparison between basal-bolus insulin and correctional insulin

Yang,

Bourgeois,

Delgado

et al. 2024

J. pharm. pharm. sci.

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PurposeThis study evaluated the safety and efficacy of two insulin regimens for inpatient hyperglycemia management: combination short-plus long-acting insulin (basal-bolus insulin regimen, BBIR) vs. short-acting insulin only (correctional insulin only regimen, CIOR).MethodsChart reviews identified noncritically ill patients with pre-existing type 2 diabetes mellitus receiving insulin injections. Study participants (N = 138) were divided into BBIR (N = 104) and CIOR (N = 34) groups. Data for the entire duration of each patient’s stay were analyzed.ResultsThe primary outcome of percent hyperglycemic days was higher in BBIR vs. CIOR (3.97 ± 0.33% vs. 1.22 ± 0.38%). The safety outcome of percent hypoglycemic events was not different between BBIR and CIOR (0.78 ± 0.22% vs. 0.53 ± 0.37%). Regarding secondary outcomes, the percentage of euglycemic days was lower in BBIR vs. CIOR (26.74 ± 2.97% vs. 40.98 ± 5.91%). Overall blood glucose (BG) and daily insulin dose were higher in BBIR vs. CIOR (231.43 ± 5.37 vs. 195.55 ± 6.25 mg/dL and 41.36 ± 3.07 vs. 5.02 ± 0.68 units, respectively). Insulin regimen-associated differences in hyperglycemia and daily insulin dose persisted after adjusting for covariates.ConclusionOur observations linking BBIR to worse glycemic outcomes differ from those reported in the randomized controlled Rabbit 2 and Rabbit 2 Surgery trials. This discrepancy can be partly explained by the fact that BBIR patients displayed worse glycemic baselines. Also, there was no diabetes stewardship team to monitor BG and modify insulin therapy, which is relevant since achieving euglycemia in BBIR patients requires more dose adjustments. This study highlights challenges with standard inpatient glycemic management and calls for further research assessing the benefits of pharmacist-led diabetes stewardship.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Real-world community hospital hyperglycemia management in noncritically ill, type 2 diabetic patients: a comparison between basal-bolus insulin and correctional insulin

Yang,

Bourgeois,

Delgado

et al. 2024

J. pharm. pharm. sci.

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show abstract

“…7-9 The American Diabetes Association (ADA) recommends adding or increasing insulin posthospital discharge if diabetes is uncontrolled, and especially with hemoglobin A1c (HbA1c) level >9%. 10 Unfortunately, clinical inertia in advancing diabetes medication regimens persists despite well-documented clinical risks of having HbA1c levels above goal. 11…”

mentioning

confidence: 99%

Developing a Diabetes Discharge Order Set for Patients With Diabetes on Insulin

Miles,

McKnight,

Schmitz

et al. 2024

J Diabetes Sci Technol

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Background: Insulin, a high-risk medication, is prone to prescribing errors. Patients with diabetes experience higher hospitalization rates and extended hospital stays. Prescription errors, such as missing orders, inappropriate insulin type, missing instructions, and lack of appropriate intensification of insulin regimens are common issues. This project explored the use of system-based interventions and educational tools to minimize errors and improve the quality of insulin discharge regimens. Methods: A needs assessment and baseline chart review were conducted before adapting a diabetes order set obtained from the University of California, San Diego. Subsequent beta testing and broader implementation were followed by repeat chart reviews to assess the impact. Results: Providers strongly desired an insulin discharge order set, with 98% of those surveyed expressing this preference. Those who were high utilizers of the order set showed increased rates of ordering all supplies (55%), compared with pre-intervention rates (27%). However, no change was observed in the practice of intensifying insulin regimens in patients with uncontrolled diabetes upon discharge. Discussion: Insulin prescribing is prone to error. A diabetes discharge order set may improve the percentage of patients who receive necessary insulin supplies at discharge and provide educational resources to encourage appropriate insulin regimens at hospital discharge.

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“…In a diabetes stewardship program, pharmacists are actively involved in glycemic management, including daily BG assessment and insulin dose adjustment. Through close monitoring of BG and adjustment of insulin dose on an as-needed basis, diabetic stewardship can improve patient outcomes and increase the use of guideline-recommended insulin regimens [7]. Pharmacist-led diabetes management may also lead to increased physician satisfaction with glycemic management, allowing them to focus on treating the acute active illness.…”

Section: Journal Of Pharmacy and Pharmaceutical Sciencesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Collaboration of Hospital Pharmacists and Hospitalists to Address Glycemic Control of General Medicine Patients: Implementation of a Pilot Inpatient Diabetes Management Program

Abstract: This study examined the clinical benefits of a collaborative pharmacist-physician inpatient diabetes management program that included daily blood glucose assessment and the recommendation and implementation of American Diabetes Association-recommended insulin regimens.

Cited by 5 publications

References 19 publications

Real-world community hospital hyperglycemia management in noncritically ill, type 2 diabetic patients: a comparison between basal-bolus insulin and correctional insulin

Real-world community hospital hyperglycemia management in noncritically ill, type 2 diabetic patients: a comparison between basal-bolus insulin and correctional insulin

Developing a Diabetes Discharge Order Set for Patients With Diabetes on Insulin

Table1.docx

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