Evaluation of protocol-guided scheduled basal-nutritional-correction insulin over standard care for vascular surgery...

Practice guidelines have recommended scheduled basal, nutritional and correction insulin to manage hyperglycemia in the hospital setting. For many decades, however, the primary practice has been sliding scale insulin.

To evaluate the efficacy and safety of an institution-specific basal-nutritional-correction insulin preprinted order (BNC-PPO).

A retrospective, single-centre chart review was conducted on patients admitted to a vascular surgery service to compare inpatient glycemia control before and after implementation of the BNC-PPO. Patients were included if they were aged 19 years or more, admitted between June 2009 and December 2010 (for pre-BNC-PPO) or between April 2011 and August 2012 (for post-BNC-PPO), required insulin before admission for their diabetes mellitus (type 1 or 2) and were prescribed insulin during their admission.

For the primary outcome, the mean (±SD) daily blood glucose during hospital stay was 9.83±1.74 mmol/L for the pre-BNC-PPO group and 8.79±1.60 mmol/L for the post-BNC-PPO group (p=0.005). Mean (±SD) severe hyperglycemia episodes per patient per day had decreased in the BNC-PPO group: 1.13±0.73 and 0.80±1.02 for the before and after groups, respectively (p=0.008). Hypoglycemia (blood glucose <2.2 mmol/L and <4 mmol/L) and mild and moderate hyperglycemia episodes were no different between groups.

A structured and proactive approach to inpatient hyperglycemia management appears to be more effective (reduced mean daily blood glucose and severe hyperglycemia episodes) and safer (no increase in hypoglycemia episodes) in maintaining glycemia control in insulin-dependent diabetes patients.