Diabetes care in hospital—the impact of a dedicated inpatient care team

Flanagan, Daniel; Moore, Eileen M.; Baker, Scott; Wright, Don; Lynch, Peter

doi:10.1111/j.1464-5491.2007.02326.x

Cited by 81 publications

(92 citation statements)

References 23 publications

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“…Previous studies have proposed and shown the benefit of a specialized care team in the management of inpatient diabetes and of overcoming clinical inertia. [30][31][32] Given the impending shortfall in the U.S. endocrinology workforce, 33 other medical specialties may not be able to depend in the future on the availability of these experts to assist with the management of their inpatient diabetes cases. The type of strategies introduced to assist physicians in overcoming clinical inertia in the hospital may depend on the specialty or type of service, as experience or expertise will vary.…”

Section: Discussionmentioning

confidence: 99%

Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification

Coan

Schlinkert

Beck

et al. 2013

J Diabetes Sci Technol

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Objective:Our objective was to assess the application of insulin regimens in surgical postoperative patients with diabetes. Methods:A chart review was conducted of patients with diabetes who were hospitalized postoperatively between January 1 and April 30, 2011. Analysis was restricted to patients hospitalized for ≥3 days and excluded cases with an endocrinology consult. Insulin regimens were categorized as "basal plus short acting," "short acting only," or "none," and the pattern of use was evaluated by hyperglycemia severity according to tertiles of both mean glucose and the number of glucose measurements >180 mg/dl. Results:Among cases selected for analysis (n = 119), examination of changes in insulin use based on tertiles of mean glucose showed that use of basal plus short-acting insulin increased from 10% in the lowest tertile (mean glucose, 120 mg/dl) to 18% in the highest tertile (mean glucose, 198 mg/dl; p < .01); however, 70% of patients in the highest tertile continued to receive short-acting insulin only, with 12% receiving no insulin. Intensification of insulin to a basal plus short-acting regimen was also seen when changes were evaluated by the number of measurements >180 mg/dl (p < .01), but 70% and 12% of patients in the highest tertile still remained only on short-acting insulin or received no insulin, respectively. Conclusions:Use of basal plus short-acting insulin therapy increased with worsening hyperglycemia, but many cases did not have therapy intensified to the recommended insulin regimen-evidence of clinical inertia. Strategies should be devised to overcome inpatient clinical inertia in the treatment of postoperative patients with diabetes.

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Section: Discussionmentioning

confidence: 99%

Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification

Coan

Schlinkert

Beck

et al. 2013

J Diabetes Sci Technol

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show abstract

“…Involvement of the diabetes specialist nurse team as standard in-patient care for adults with diabetes is vital and evidence suggests that it reduces length of stay and improves safety. 12,13 Furthermore, JBDS guidance suggests that patients admitted with DKA should receive psychological support prior to discharge. However the advisory group set up to formulate the Best Practice Tariff (BPT) for DKA advised that inclusion of psychological support within the BPT was "a step too far" and that the challenges seemed insurmountable.…”

Section: Discussionmentioning

confidence: 99%

Management of diabetic ketoacidosis following implementation of the JBDS guidelines: Where are we and where should we go?

et al. 2015

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“…The formation of a dedicated inpatient DM team would likely be impactful. 18 This evaluation has clarifi ed the extent of the burden of inpatient DM in Barbados as well as areas where improvement is needed. It has also provided a baseline against which the effectiveness of changes can be measured.…”

Section: Resultsmentioning

confidence: 99%

The extensive inpatient burden of diabetes and diabetes-related foot disease in Barbados

et al. 2014

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In this study, we evaluated the burden and quality of adult inpatient diabetes care in Barbados. Inpatients were reviewed over 2 days to identify those with diabetes. Data were collected and analysed from identifi ed patients, their notes and management charts using an audit methodology developed in the UK. Inpatient diabetes prevelance was found to be 42.5% (111 of 261 beds audited). Insulin-treated type 2 diabetes affected 41.8% of the patients. Diabetic foot disease accounted for 30% of admissions and 89% of diabetes-related admissions. Of the patients admitted without diabetic foot disease, 13.9% had their feet examined and 2.8% developed foot lesions during their stay. Medication errors were experienced by 41.4% of patients. We recorded the prevalence of inpatient diabetes in the English medical literature (42.5%) and this was signifi cantly driven by diabetic foot disease. Care needs were complex and areas of potential improvement were identifi ed.

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Diabetes care in hospital—the impact of a dedicated inpatient care team

Abstract: In conclusion, a team specifically employed to focus on inpatient diabetes care has a significant impact on LOS of this patient group.

Cited by 81 publications

References 23 publications

Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification

Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification

Management of diabetic ketoacidosis following implementation of the JBDS guidelines: Where are we and where should we go?

The extensive inpatient burden of diabetes and diabetes-related foot disease in Barbados

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