| Maintaining glycemic control when transitioning from infusion insulin: a protocol-driven, multidisciplinary approach. | |
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MedLine Citation:
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PMID: 20945469 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: An observational pilot study of 41 medical and surgical intensive care patients on infusion insulin at our own institution found that glycemic control rapidly deteriorated within 48 hours of stopping infusion insulin. This prompted the design and testing of a transition protocol. METHODS: The transition protocol identified appropriate patients for subcutaneous (SC) insulin along with the insulin dose and schedule. A pharmacist-hospitalist improvement team offered protocol guidance but adherence was left to the discretion of the provider. The primary endpoints were mean blood glucose the first and second day after stopping the insulin infusion and the number of patients with hypoglycemia (41-70 mg/dL) and severe hypoglycemia (<40 mg/dL) during the 48-hour transition. Secondary endpoints include severe hyperglycemia (>300 mg/dL), length of stay (LOS), re-initiation of the infusion insulin, day-weighted glucose mean 12 days following transition for patients with diabetes, and identification of a new diagnosis of diabetes. RESULTS: Patients with diabetes transitioned by protocol (n = 33) had better glycemic control than those (n = 39) transitioned without the protocol (Day 1 population glucose mean of 168 mg/dL vs. 211 mg/dL [P<0.001], Day 2 means of 176 mg/dL vs 218 mg/dL [P<0.001]). Severe hypoglycemia occurred once in each group. There were 14 patients newly diagnosed with diabetes based on an A1c ≥6%. Patients with stress hyperglycemia maintained good glycemic control with correctional insulin only. CONCLUSION: Protocol adherence improved glycemic control, reduced unnecessary use of insulin, and identified patients with previously undiagnosed diabetes, without any increase in hypoglycemia. |
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Authors:
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Pedro Ramos; Diana Childers; Greg Maynard; Kevin Box; Jennifer Namba; Kelli Stadalman; Marian Renvall |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of hospital medicine : an official publication of the Society of Hospital Medicine Volume: 5 ISSN: 1553-5606 ISO Abbreviation: J Hosp Med Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-10-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101271025 Medline TA: J Hosp Med Country: United States |
Other Details:
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Languages: eng Pagination: 446-51 Citation Subset: IM |
Affiliation:
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Division of Hospital Medicine, UCSD Medical Center, San Diego, California, USA. prramos@ucsd.edu |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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