Inpatient management of diabetes and hyperglycemia among general medicine patients at a large teaching hospital
| Autor: | Garrett M. Fitzmaurice, Emily E. Barsky, Jeffrey L. Schnipper, Shimon Shaykevich, Merri Pendergrass |
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| Rok vydání: | 2007 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty Leadership and Management medicine.medical_treatment Assessment and Diagnosis Hypoglycemia Cohort Studies Diabetes mellitus medicine Diabetes Mellitus Humans Prospective Studies Intensive care medicine Prospective cohort study Hospitals Teaching Care Planning Glycemic Aged Inpatients business.industry Health Policy Insulin Disease Management General Medicine Middle Aged medicine.disease Hospital medicine Hospitalization Basal (medicine) Glycemic Index Hyperglycemia Emergency medicine Fundamentals and skills Female business Family Practice Cohort study |
| Zdroj: | Journal of hospital medicine. 1(3) |
| ISSN: | 1553-5606 |
| Popis: | BACKGROUND Because of the relationship between inpatient hyperglycemia and adverse patient outcomes, current guidelines recommend glucose levels less than 180 mg/dL in the non-ICU inpatient setting and the use of effective insulin protocols for appropriate patients. OBJECTIVE To determine the current state of glucose management on an academic hospitalist service and the relationship between insulin-ordering practices and glycemic control. DESIGN Prospective cohort study. SETTING Hospitalist-run general medicine service of an academic teaching hospital. PATIENTS 107 consecutive patients with diabetes mellitus or inpatient hyperglycemia. MEASUREMENTS We collected data on up to 4 bedside glucose measurements per day, detailed clinical information, and all orders related to glucose management. The primary outcomes were rate of hyperglycemia (glucose > 180 mg/dL) per patient and mean glucose level per patient-day. RESULTS The mean rate of hyperglycemia was 31% of measurements per patient. Basal insulin was ordered for 43% of patients, and scheduled rapid- or short-acting insulin was ordered for 4% of patients. Sixty-five percent of patients who had at least 1 episode of hyper- or hypoglycemia had no change made to any insulin order during the first 5 days of the hospitalization. When adjusted for clinical factors, the use of sliding-scale insulin by itself was associated with a 20 mg/dL higher mean glucose level per patient-day. CONCLUSIONS Management of diabetes and hyperglycemia on a general medicine service showed several deficiencies in process and outcome. Possible targets for improvement include increased use of basal and nutritional insulin and daily insulin adjustment in response to hyperglycemia. Journal of Hospital Medicine 2006;3:145–150. © 2006 Society of Hospital Medicine. |
| Databáze: | OpenAIRE |
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