Transitioning Insulin Pump Therapy from the Outpatient to the Inpatient Setting: A Review of 6 Years' Experience with 253 Cases

Patients' knowledge of their insulin pumps and glucose control during hospitalization has not been studied. The aim was to study the determinants of glycemic control in patients using continuous subcutaneous insulin infusion (CSII) in the hospital. Three groups of patients were identified: those who did not need any inpatient education and continued on CSII (gorup A), those who received education then continued on CSII (group B), and those for whom CSII was not appropriate and were treated with multiple daily insulin injections (gorup C). We compared the measures of glycemic control between the 3 groups and analyzed which variables impacted glucose control. There were 50 patients, with 51 hospital admissions, 57% males, mean age 48 ± 13 years, 86% had type 1 diabetes (T1DM). The mean DM duration was 26 ± 14 years, mean duration of CSII use was 8.7 ± 6 years, and mean HbA1c was 7.6 ± 1.4%. The mean duration of hospital stay was 5.6 ± 4.6 days. Mean blood glucose (BG) and frequency of hyperglycemia and hypoglycemic events among the 3 groups adjusted for their duration of hospital stay were not statistically different. None of the patients developed diabetic ketoacidosis while using their pump.Stepwise multivariate analysis revealed knowledge of hypoglycemia correction was the single most important predictor of mean BG (P < .001). Patients who received inpatient education performed similarly to patients who did not need inpatient education. Patients who receive inpatient education on CSII fare similar as patients who did not require inpatient education.

Section: Discussionmentioning

confidence: 99%

Insulin Pump Patient Characteristics and Glucose Control in the Hospitalized Setting

Kannan

Satra

Calogeras

et al. 2014

“…[20][21][22][23][24] This reports a standardized approach from 1 institution, and experiences from other institutions with perioperative CSII management are needed and would contribute greatly to our understanding on how to approach care of these patients. Reviewing and aggregating these different institutional experiences would facilitate development of more generalizable recommendations.…”

Section: -4mentioning

confidence: 99%

Update on a Quality Initiative to Standardize Perioperative Care for Continuous Subcutaneous Insulin Infusion Therapy

Mackey

Thompson

Boyle

et al. 2015

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Objective: The objective of the analysis was to review the effectiveness of a care process model (CPM) developed to guide management of patients on insulin pump therapy undergoing elective surgical procedures. Methods: Electronic medical records were reviewed to assess the impact of the CPM on documentation of insulin pump status, glucose monitoring, and safety during the perioperative phase of care. Post-CPM care was compared with management provided before CPM implementation. Results: We reviewed 45 cases on insulin pump therapy in the pre-CPM cohort and 106 in the post-CPM cohort. Demographic characteristics, categories of surgery, and perioperative times were not significantly different between the 2 groups. Recommended hemoglobin A1c monitoring occurred in 73% of cases in the pre-CPM cohort but improved to 94% in the post-CPM group ( P < .01). There was a higher frequency of documentation of the insulin pump during the preoperative, intraoperative, and postanesthesia care unit segments of care in the post- vs pre-CPM periods (all P < .01). The number of cases with intraoperative glucose monitoring increased (57% pre-CPM vs 81% post-CPM; P < .01). Glycemic control was comparable between the 2 CPM periods. Hypoglycemia was rare, with only 3 episodes in the pre-CPM group and 4 in the post-CPM. No adverse events associated with perioperative insulin pump use were observed. Conclusions: This analysis adds to previous data on use of insulin pump therapy during the perioperative period. Some processes require additional attention, but data continue to indicate that a standardized approach to care can lead to a successful and safe transition of insulin pump therapy throughout the perioperative period.

“…19,20 Moreover, our hospital has a long-standing policy allowing individual patients on outpatient CSII therapy to transition that technology to the inpatient setting. 10 Part of that process involves completion of an electronic order set (for current format, see Figure 1). The DTSC simulation walked the resident stepwise through the ordering process.…”

Section: Overview Of Diabetes Technology Simulation Coursementioning

confidence: 99%

“…5,[7][8][9] While CSII and CGMS are intended for outpatient use, these devices are also being encountered by inpatient clinical care teams. 10,11 Technology-enhanced simulation can improve learning outcomes. 12 Simulations of clinical cases can be delivered through various modalities, including computers or mobile devices (screen-based patient simulation) or in person (immersive patient simulation).…”

Section: Introductionmentioning

confidence: 99%

Description and Preliminary Evaluation of a Diabetes Technology Simulation Course

Wilson

Bailey

Boyle

et al. 2013

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