Overcoming Clinical Inertia in the Management of Postoperative Patients with Diabetes |
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| Affiliation: | 1. Department of Surgery;2. Department of Information Technology, Mayo Clinic Hospital, Phoenix, Arizona;3. Division of Planning Services and Practice Analysis;4. Division of Endocrinology;5. Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Scottsdale, Arizona.;1. Department of Endocrinology, University Hospital Complex, Albacete, Spain;2. Departments of Endocrinology and Molecular Genetics,;3. Clinical Genetics, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, United Kingdom.;1. The Hilda and J. Lester Gabrilove Division of Endocrinology, Diabetes, and Bone Disease, Department of Medicine, The Mount Sinai Hospital, New York, New York;2. Department of Urology, The Mount Sinai Hospital, New York, New York.;1. Interdisziplinäre Endokrinologie, Diabetologie und Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf,;2. Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf;3. Klinik und Poliklinik für Nuklearmedizin, Zentrum für Radiologie und Endoskopie, Hamburg, Germany. |
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| Abstract: | ObjectiveTo assess the impact of an intervention designed to increase basal-bolus insulin therapy administration in postoperative patients with diabetes mellitus.MethodsEducational sessions and direct support for surgical services were provided by a nurse practitioner (NP). Outcome data from the intervention were compared to data from a historical (control) period. Changes in basalbolus insulin use were assessed according to hyperglycemia severity as defined by the percentage of glucose measurements > 180 mg/dL.ResultsPatient characteristics were comparable for the control and intervention periods (all P ≥ .15). Overall, administration of basal-bolus insulin occurred in 9% (8/93) of control and in 32% (94/293) of intervention cases (P < .01). During the control period, administration of basal-bolus insulin did not increase with more frequent hyperglycemia (P = .22). During the intervention period, administration increased from 8% (8/96) in patients with the fewest number of hyperglycemic measurements to 60% (57/95) in those with the highest frequency of hyperglycemia (P < .01). The mean glucose level was lower during the intervention period compared to the control period (149 mg/dL vs. 163 mg/dL, P < .01). The proportion of glucose values > 180 mg/dL was lower during the intervention period than in the control period (21% vs. 31% of measurements, respectively, P < .01), whereas the hypoglycemia (glucose < 70 mg/dL) frequencies were comparable (P = .21).ConclusionAn intervention to overcome clinical inertia in the management of postoperative patients with diabetes led to greater utilization of basal-bolus insulin therapy and improved glucose control without increasing hypoglycemia. These efforts are ongoing to ensure the delivery of effective inpatient diabetes care by all surgical services. (Endocr Pract. 2014;20:320-328) |
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