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12:08
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Maintaining glycemic control when transitioning from infusion insulin: a protocol-driven, multidisciplinary approach.
Pedro Ramos1, Diana Childers, Greg Maynard
1Division of Hospital Medicine, UCSD Medical Center, San Diego, California, USA. prramos@ucsd.edu
Journal of Hospital Medicine
|October 15, 2010
Summary
A new protocol for transitioning patients from infusion insulin to subcutaneous insulin improved glycemic control and identified undiagnosed diabetes cases. Adherence to the protocol reduced unnecessary insulin use without increasing hypoglycemia risk.
Area of Science:
- Intensive care medicine
- Endocrinology
- Diabetes management
Background:
- Infusion insulin cessation in intensive care units (ICUs) can lead to rapid glycemic control deterioration.
- A pilot study highlighted the need for a structured protocol to manage insulin transitions.
- This led to the development and testing of a transition protocol.
Purpose of the Study:
- To evaluate the effectiveness of a new transition protocol for patients on infusion insulin.
- To assess glycemic control, hypoglycemia, and hyperglycemia rates during insulin transitions.
- To identify previously undiagnosed diabetes cases.
Main Methods:
- A transition protocol was developed to guide patient selection, insulin dosing, and scheduling for subcutaneous (SC) insulin.
- A pharmacist-hospitalist team provided guidance, with provider discretion for adherence.
- Primary endpoints included mean blood glucose, hypoglycemia, and severe hypoglycemia within 48 hours post-transition.
Main Results:
- Patients transitioned using the protocol demonstrated significantly better glycemic control compared to those without (Day 1 mean glucose: 168 vs. 211 mg/dL; Day 2 mean glucose: 176 vs. 218 mg/dL).
- Severe hypoglycemia rates were similar between groups (one event each).
- Fourteen patients were newly diagnosed with diabetes (A1c ≥6%), and patients with stress hyperglycemia were managed effectively with correctional insulin.
Conclusions:
- Protocol adherence significantly improved glycemic control in patients transitioning from infusion insulin.
- The protocol helped reduce unnecessary insulin use and identified patients with previously undiagnosed diabetes.
- No increase in hypoglycemia was observed with protocol implementation.
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