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Intensive insulin protocol implementation and outcomes in the medical and surgical wards at a Veterans Affairs Medical Center.
Ann Pharmacother. 2010 Feb; 44(2):249-56.AP

Abstract

BACKGROUND

Hyperglycemia is an important marker for clinical outcomes and mortality in hospitalized patients. New national standards have been established emphasizing the importance of improving inpatient glycemic control in individuals with diabetes or new-onset hyperglycemia. Implementation of these new standards is complex and requires a multidisciplinary team approach. A basal-bolus insulin regimen approach has been shown to improve inpatient glycemic control. Few studies have been published regarding basal-bolus insulin protocol outcomes in the non-intensive care unit (ICU) setting.

OBJECTIVE

To evaluate the efficacy of a basal-bolus insulin protocol on inpatient glycemic control in a non-ICU setting, as measured by mean blood glucose and number of hypoglycemic episodes per patient admission.

METHODS

A retrospective, observational, single-center study was conducted to compare blood glucose control pre- (October 2006-March 2007) and postprotocol (November 2007-January 2008) implementation. Inclusion criteria consisted of patient admission to a medical or surgical ward for at least 72 hours, with a diagnosis of diabetes, or presentation with 2 blood glucose readings greater than 180 mg/dL. Patients admitted to the ICU or those not admitted to a medical or surgical ward were excluded.

RESULTS

Following protocol implementation, the mean +/- SD blood glucose level increased from 174 +/- 88 mg/dL to 188 +/- 95 mg/dL (p < 0.001) and the hypoglycemic incidents significantly decreased, from 1.11 to 0.51 events per patient admission (p < 0.0025).

CONCLUSIONS

In this pilot study, implementation of a basal-bolus insulin protocol significantly reduced hypoglycemic events; however, mean blood glucose values increased. These results suggest that a basal-bolus insulin protocol can reduce hypoglycemia; however, factors such as protocol compliance, barriers in overcoming the use of the traditional sliding scale insulin regimens, staff education, and change of work-flow habits can influence the overall efficacy and impact of a basal-bolus insulin protocol on inpatient glycemic control.

Authors+Show Affiliations

Department of Pharmacy, Lexington Veterans Affairs Medical Center, Lexington, KY, USA. helen.chen@med.navy.milNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20103610

Citation

Chen, Helen J., et al. "Intensive Insulin Protocol Implementation and Outcomes in the Medical and Surgical Wards at a Veterans Affairs Medical Center." The Annals of Pharmacotherapy, vol. 44, no. 2, 2010, pp. 249-56.
Chen HJ, Steinke DT, Karounos DG, et al. Intensive insulin protocol implementation and outcomes in the medical and surgical wards at a Veterans Affairs Medical Center. Ann Pharmacother. 2010;44(2):249-56.
Chen, H. J., Steinke, D. T., Karounos, D. G., Lane, M. T., & Matson, A. W. (2010). Intensive insulin protocol implementation and outcomes in the medical and surgical wards at a Veterans Affairs Medical Center. The Annals of Pharmacotherapy, 44(2), 249-56. https://doi.org/10.1345/aph.1M501
Chen HJ, et al. Intensive Insulin Protocol Implementation and Outcomes in the Medical and Surgical Wards at a Veterans Affairs Medical Center. Ann Pharmacother. 2010;44(2):249-56. PubMed PMID: 20103610.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intensive insulin protocol implementation and outcomes in the medical and surgical wards at a Veterans Affairs Medical Center. AU - Chen,Helen J, AU - Steinke,Douglas T, AU - Karounos,Dennis G, AU - Lane,Matthew T, AU - Matson,Adrienne W, Y1 - 2010/01/26/ PY - 2010/1/28/entrez PY - 2010/1/28/pubmed PY - 2010/4/27/medline SP - 249 EP - 56 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 44 IS - 2 N2 - BACKGROUND: Hyperglycemia is an important marker for clinical outcomes and mortality in hospitalized patients. New national standards have been established emphasizing the importance of improving inpatient glycemic control in individuals with diabetes or new-onset hyperglycemia. Implementation of these new standards is complex and requires a multidisciplinary team approach. A basal-bolus insulin regimen approach has been shown to improve inpatient glycemic control. Few studies have been published regarding basal-bolus insulin protocol outcomes in the non-intensive care unit (ICU) setting. OBJECTIVE: To evaluate the efficacy of a basal-bolus insulin protocol on inpatient glycemic control in a non-ICU setting, as measured by mean blood glucose and number of hypoglycemic episodes per patient admission. METHODS: A retrospective, observational, single-center study was conducted to compare blood glucose control pre- (October 2006-March 2007) and postprotocol (November 2007-January 2008) implementation. Inclusion criteria consisted of patient admission to a medical or surgical ward for at least 72 hours, with a diagnosis of diabetes, or presentation with 2 blood glucose readings greater than 180 mg/dL. Patients admitted to the ICU or those not admitted to a medical or surgical ward were excluded. RESULTS: Following protocol implementation, the mean +/- SD blood glucose level increased from 174 +/- 88 mg/dL to 188 +/- 95 mg/dL (p < 0.001) and the hypoglycemic incidents significantly decreased, from 1.11 to 0.51 events per patient admission (p < 0.0025). CONCLUSIONS: In this pilot study, implementation of a basal-bolus insulin protocol significantly reduced hypoglycemic events; however, mean blood glucose values increased. These results suggest that a basal-bolus insulin protocol can reduce hypoglycemia; however, factors such as protocol compliance, barriers in overcoming the use of the traditional sliding scale insulin regimens, staff education, and change of work-flow habits can influence the overall efficacy and impact of a basal-bolus insulin protocol on inpatient glycemic control. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/20103610/Intensive_insulin_protocol_implementation_and_outcomes_in_the_medical_and_surgical_wards_at_a_Veterans_Affairs_Medical_Center_ L2 - https://journals.sagepub.com/doi/10.1345/aph.1M501?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -