Analysis of a Guideline-Derived Resident Educational Program on Inpatient Glycemic Control

To determine the effects of a guideline-derived resident educational program on inpatient glycemic control and length of hospital stay (LOS).

We compared the following variables before and after resident education: percentage of patients on basal-plus-bolus regimens, mean fingerstick glucose (FSG), LOS, and rates of hypoglycemia (FSG<70 mg/dL) and severe hypoglycemia (FSG<40 mg/dL). A two-tailed t test was used for all continuous data and P<0.05 was considered statistically significant.

After education, more patients (23% vs 8%; P=0.024) were placed on basal-plus-bolus regimens. We observed a decrease in mean FSG (158.7 mg/dL vs 165.1 mg/dL; P=0.028) and LOS (5.03 days vs 6.98 days; P=0.042). Rates of hypoglycemia (4.6% vs 1.5%; P<0.001) and severe hypoglycemia (0.71% vs 0.24%; P=0.089) increased.

Our resident educational program significantly increased the number of patients receiving guideline-based inpatient insulin therapy and was associated with a reduction in mean FSG and LOS. Rates of hypoglycemia showed a statistically significant increase, whereas rates of severe hypoglycemia did not. Larger multicenter studies with adjustment for potential confounders are needed to further assess the impact of educational interventions on inpatient glycemic control.