Inpatient Management of Diabetes Mellitus among Noncritically Ill Patients at the University Hospital of Puerto Rico.
Endocr Pract. 2013 Dec 10;:1-26
Authors: Allende-Vigo MZ, González-Rosario RA, González L, Sánchez V, Vega MA, Alvarado M, Ramón RO
Objective: To describe the state of glycemic control in non-critically ill diabetic patients admitted to the Puerto Rico University Hospital, and the adherence to current standard of care guidelines for the treatment of diabetes.Methods: This was a retrospective study of patients admitted to a General Medicine ward with diabetes mellitus as a secondary diagnosis. Clinical data of the first 5 days and the last 24 hours of hospitalization were analyzed.Results: One hundred and forty-seven (147) non-critically ill diabetic patients were evaluated. The rate of hyperglycemia (blood glucose ≥180 mg/dL) and hypoglycemia (blood glucose < 70 mg/dL) was 56.7% and 2.8%, respectively. Nearly 60% of patients were hyperglycemic during the first 24 hours of hospitalization (mean random blood glucose 226.5 mg/dL) and 54.2% during the last 24 hours of hospitalization (mean 196.51 mg/dL). Mean random last glucose value before discharge was 189.6 mg/dL. Most patients were treated with subcutaneous insulin, with basal insulin alone (60%) used as the most common regimen. The proportion of patients classified as uncontrolled receiving basal-bolus therapy increased from 54.3% on day 1 to 60.0% on day 5, with 40.0% continuing to receive only basal insulin. Most of the uncontrolled patients had their insulin dose increased (70.1%), however, a substantial portion had no change (23.7%), or even a decrease (6.2%) in their insulin dose.Conclusions: The management of hospitalized diabetic patients is suboptimal, probably due to clinical inertia, manifested by absence of appropriate modification of insulin regimen and intensification of dose in uncontrolled diabetic patients. A comprehensive educational diabetes management program, along with standardized insulin orders, should be implemented to improve the care of these patients.
PMID: 24325996 [PubMed - as supplied by publisher]