Insulin for Hospitalized Patients With Well-Controlled Type 2 Diabetes Mellitus: A Quality Improvement Initiative

Area of Science:

• Internal Medicine
• Endocrinology
• Quality Improvement

Background:

• Inpatient diabetes mellitus (DM) management often leads to increased insulin use.
• Current practices may result in unnecessary insulin administration, particularly for patients with controlled HbA1c levels.

Purpose of the Study:

• To evaluate the impact of an evidence-based care pathway on inpatient insulin use.
• To assess changes in glucose control and adverse events following the pathway implementation.

Main Methods:

• Retrospective observational study with preintervention and postintervention analysis.
• Interrupted time series analysis to evaluate trends over a 21-month period.
• Focus on patients with recent HbA1c < 8% and no outpatient insulin prescription.

Main Results:

• Mean daily insulin units decreased significantly from 2.7 to 1.7 units per hospitalization (p = .017).
• A downward trend in glucose and insulin use was observed within 72 hours post-intervention.
• The proportion of patients receiving zero insulin increased from 27.7% to 52.5% (p < .001).
• No significant changes in hypoglycemic or hyperglycemic events were noted.

Conclusions:

• An evidence-based inpatient DM care pathway effectively reduced insulin administration.
• The implemented pathway improved insulin use efficiency without compromising patient safety.
• This approach offers a valuable strategy for optimizing diabetes care in hospitalized patients.