Management of Inpatient Hyperglycemia: Assessing Perceptions and Barriers to Care Among Resident Physicians |
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| Institution: | 1. Division of Endocrinology, Rochester, Minnesota.;2. Division of Hospital Internal Medicine, Rochester, Minnesota.;3. Division of Community Internal Medicine, Rochester, Minnesota.;4. Section of Planning Services and Practice Analysis, Mayo Clinic Arizona, Scottsdale, Arizona,;5. Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic Rochester, Rochester, Minnesota.;1. School of Psychology, Deakin University, Geelong, Victoria, Australia;2. The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia;3. University of Melbourne, Department of Medicine, St Vincent''s Hospital, Melbourne, Australia;4. NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia;5. School of Psychology and Clinical Sciences, Charles Darwin University, Casuarina, Northern Territory, Australia;7. AHP Research, Hornchurch, Essex, UK |
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| Abstract: | Objective:To develop insight into resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal management.Methods:As part of a planned educational program, a questionnaire was designed and administered to determine the opinions of residents about the importance o inpatient glucose control, their perceptions about what glucose ranges were desirable, and the problems they encountered when trying to manage hyperglycemia in hospitalized patients.ResultsOf 70 resident physicians from various services, 52 completed the survey (mean age, 31 years; 48% men; 37% in first year of residency training). Most respondents indicated that glucose control was “very important” in critically ill and perioperative patients but only “somewhat important” in non-critically ill patients. Most residents indicated that they would target a therapeutic glucose range within the recommended levels in published guidelines. Most residents also said they felt “somewhat comfortable” managing hyperglycemia and hypoglycemia and using subcutaneous insulin therapy. whereas most residents (48%) were “not at all comfortable” with use of intravenous administration of insulin. In general, respondents were not very familiar with existing institutional policies and preprinted order sets relating to glucose management. The most commonly reported barrier to management of inpatient hyperglycemia was lack of knowledge about appropriate insulin regimens and how to use them. Anxiety about hypoglycemia was only the third most frequent concern.ConclusionMost residents acknowledged the importance of good glucose control in hospitalized patients and chose target glucose ranges consistent with existing guidelines. Lack of knowledge about insulin treatment options was the most commonly cited barrier to ideal management. Educational programs should emphasize inpatient treatment strategies for glycemic control. (Endocr Pract. 2007;13:117-125) |
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