Improving Management of Type 2 Diabetes Mellitus in Hospitalized Adults: A Quality Initiative

Abstract

The American Diabetes Association recommends scheduled basal and nutritional insulin doses as the preferred treatment for noncritically ill hospitalized patients with type 2 diabetes; however, the adoption of these practices remains suboptimal. We sought to understand current diabetes management practices and improve glycemic control in patients with type 2 diabetes on the Hospital Medicine Services at our academic medical center. We surveyed resident and attending physicians to understand barriers to guideline-based practice. We conducted educational sessions, developed pocket-card decision aids, encouraged discussion on rounds, and provided periodic performance feedback to attending physicians. Results of the barriers survey identified “fear of causing hypoglycemia” as the most common barrier to guideline-based practice. Compared with the preintervention 12-month period, these interventions were associated with doubling of the use of guideline-based insulin therapy regimens, a significant reduction in the rate of severe hyperglycemia days, and a nonsignificant reduction in the rate of hypoglycemia days over a 12-month period. These results demonstrate that a simple, low-cost intervention can be associated with an increase in guideline-concordant insulin ordering with improvement in glycemic outcomes for patients with type 2 diabetes.

Promoting scholarship in improvement science: A model for academic clinical departments

“…Examples of completed initiatives to improve care delivery within divisions include implementation of routine hepatitis C screening in hospitalized adults (Division of Infectious Disease) and promoting guideline‐concordant use of basal‐bolus insulin regimens in inpatients with type 2 diabetes (Division of Hospital Medicine). 16 , 17 Similarly, individual faculty members or trainees in the department may undertake efforts to improve care value, such as a resident‐led effort to promote appropriate utilization of laboratory tests for inflammation. 18 A table summarizing the clinical QI initiatives supported by the Quality Program during fiscal years 2019 through 2021 are provided in Supporting Information .…”

“…The Quality Program supports divisions, faculty or trainees in conducting clinical QI projects based on their specific requests or needs. Examples of completed initiatives to improve care delivery within divisions include implementation of routine hepatitis C screening in hospitalized adults (Division of Infectious Disease) and promoting guideline‐concordant use of basal‐bolus insulin regimens in inpatients with type 2 diabetes (Division of Hospital Medicine) 16,17 . Similarly, individual faculty members or trainees in the department may undertake efforts to improve care value, such as a resident‐led effort to promote appropriate utilization of laboratory tests for inflammation 18 .…”