Improving glycemic control in medical inpatients: a pilot study

Area of Science:

• Internal Medicine
• Endocrinology
• Quality Improvement

Background:

• Inpatient hyperglycemia is linked to adverse patient outcomes.
• Current guidelines suggest maintaining blood glucose below 180 mg/dL in non-ICU settings.

Purpose of the Study:

• To implement a subcutaneous insulin protocol in a general medicine service.
• To identify barriers to protocol implementation.
• To assess the protocol's impact on glycemic control.

Main Methods:

• Prospective quality-improvement pilot study involving 89 patients with type 2 diabetes or hyperglycemia.
• Evaluated resident acceptance, insulin ordering practices, and mean hyperglycemia rate.
• Compared results with a prior observational study.

Main Results:

• Resident agreement to use the protocol was 56%.
• Barriers included disease severity, oral medication titration, and hypoglycemia concerns.
• Hyperglycemia rates did not significantly differ between the pilot and baseline groups.

Conclusions:

• Adherence to the inpatient subcutaneous insulin protocol was moderate.
• Key barriers identified were fear of hypoglycemia, delayed basal insulin initiation, and clinical inertia.
• Targeting these barriers is crucial for enhancing inpatient glycemic management.