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Overcoming Clinical Inertia in the Management of Postoperative Patients with Diabetes.
Endocr Pract. 2013 Nov 18;:1-25
Authors: Apsey HA, Coan KE, Castro JC, Jameson KA, Schlinkert RT, Cook CB
Abstract
Objective: Assess the impact of an intervention designed to increase basal-bolus insulin therapy administration in postoperative patients with diabetes mellitus.Methods: Educational sessions plus direct support to surgical services were provided by a nurse practitioner. Outcomes data from the intervention were compared to data from a historical (control) period. Changes in basal-bolus insulin use were assessed according to the severity of hyperglycemia as defined by the percentage of glucose measurements >180 mg/dL.Results: Characteristics of patients were comparable for the control and intervention periods (P≥15). Overall, administration of basal-bolus insulin occurred in 9% (8/93) and 32% (94/293) of cases, respectively (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). Mean glucose was lower during the intervention period than in 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; P<.01), whereas hypoglycemia (glucose <70 mg/dL) frequency was comparable (P=.21).Conclusion: An intervention to overcome clinical inertia in 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 delivery of effective inpatient diabetes care by all surgical services.
PMID: 24246354 [PubMed - as supplied by publisher]