Effect of a diabetes order set on glycaemic management and control in the hospital

Noschese, Michelle; Donihi, Amy C.; Koerbel, Glory; Karslioglu, Esra; DiNardo, Monica; Curll, Michelle; Korytkowski, Mary T.

doi:10.1136/qshc.2006.021790

Cited by 38 publications

(52 citation statements)

References 29 publications

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“…The implementation of a diabetes order set designed by a multidisciplinary team has been proved to improve DM care in part by increasing orders for scheduled basal/bolus insulin therapy and decreasing the use of SSI alone (36-37). A new order set encouraging the use of scheduled subcutaneous basal, nutritional and correction insulin is currently being implemented in our institution, along with education for residents and nurse staff about its use and proper glycemic targets.…”

Section: Discussionmentioning

confidence: 99%

Inpatient Management of Diabets Mellitus Among Noncritically Ill Patients at the University Hospital of Puerto Rico

et al. 2014

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OBJECTIVE To describe the state of glycemic control in non-critically ill diabetic patients admitted to the PR University Hospital, and the adherence to current standard of care guidelines for the treatment of diabetes. METHODS This was a retrospective study of patients admitted to a General Medicine ward with Diabetes Mellitus as a secondary diagnosis. Clinical data was analyzed for the first 5 days and the last 24 hours of admission. RESULTS One hundred and forty-seven (147) non-critically ill diabetic patients were evaluated. The rate of hyperglycemia and hypoglycemia was 56.7% and 2.8%, respectively. Nearly 60% of patients were hyperglycemic during the first 24 hrs of admission and 54.2% during the last 24 hrs. Mean last glucose value before discharge was 189.6 ± 73 mg/dL. Most patients were treated with subcutaneous insulin with basal insulin alone used as the most common regimen. The proportion of patients classified as uncontrolled receiving basal-bolus therapy increased from 54.3% on day 1 to 60.0% on day 5, with still 40.0% receiving only basal insulin. Most of the uncontrolled patients had their insulin dose increased (70.1%), however, a substantial portion had no change (23.7%) or even had a decrease (6.2%) in their insulin dose. CONCLUSIONS Even though there are areas of improvement in the management of hospitalized diabetic patients, it is still suboptimal, probably due to clinical inertia. A comprehensive educational diabetes management program, along with standardized insulin orders should be implemented to improve the care of these patients.

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Section: Discussionmentioning

confidence: 99%

Inpatient Management of Diabets Mellitus Among Noncritically Ill Patients at the University Hospital of Puerto Rico

et al. 2014

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“…Often 75–80% of the total daily intravenous infusion dose administered can be divided into basal and prandial components. This transition should ideally be carried out in a proactive manner by administering subcutaneous insulin 1–4 h before the intravenous infusion is discontinued, depending upon the type of subcutaneous insulin given [7,47,49]. When dividing the basal and prandial components, patients with a restricted caloric intake are recommended to receive 60–80% of the total daily dose as basal insulin.…”

Section: Managing Inpatient Hyperglycemia While Avoiding Hypoglycemiamentioning

confidence: 99%

Understanding hypoglycemia in hospitalized patients

Hulkower

Pollack²,

Zonszein³

2014

Diabetes Management

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SUMMARY Controlling blood glucose in hospitalized patients is important as both hyperglycemia and hypoglycemia are associated with increased cost, length of stay, morbidity and mortality. A limiting factor in stringent control is the concern of iatrogenic hypoglycemia. The association of hypoglycemia with mortality has led to clinical guideline changes recommending more conservative glycemic control than had previously been suggested, with the use of patient specific approaches when appropriate. Healthier, stable patients may be managed with stricter control while the elderly and severely ill may be managed less aggressively. While the avoidance of hypoglycemia is essential in clinical practice, recent studies suggest that a higher mortality rate occurs in spontaneous rather than iatrogenic hypoglycemia. Therefore, inpatient hypoglycemia may be viewed more as a biomarker of disease rather than a true cause of fatality.

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“…Pichardo-Lowden and Gabbay [20] in hospitalized patients in preparation for surgical procedures. Several protocols have been published guiding inpatient insulin therapy, each of which has been associated with a low risk for hypoglycemia [21][22][23][24]. Many institutions are now turning to computerized protocols as described in the manuscript by Drs.…”

mentioning

confidence: 98%