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EFFECTIVENESS OF INPATIENT INSULIN ORDER SETS USING HUMAN INSULINS IN NON-CRITICALLY ILL PATIENTS IN A RURAL HOSPITAL.
Endocr Pract. 2015 Jun 29;
Authors: Valgardson JD, Merino M, Redgrave J, Hudson JI, Hudson MS
Abstract
OBJECTIVE: Recent guidelines recommend a physiologic approach to non-intensive care unit (ICU) inpatient glucose management utilizing basal-bolus with correctional (BBC) insulin over traditional sliding scale insulin monotherapy. Unfortunately, few studies exist using a BBC approach restricted to human insulins (regular and NPH). This study evaluated changes in provider prescribing patterns, effects on blood glucose and safety with implementation of hospital order sets for BBC using human insulins.
METHODS: Order sets were developed for non-ICU inpatients consisting of basal, prandial and correctional insulin using NPH and regular human insulins. Evaluation compared a 4-month period before (admissions, n=274) with a 4-month period after order set availability (n=302). Primary outcome was change in insulin prescribing patterns. Secondary outcomes included use of non-preferred diabetes treatments, hemoglobin A1c testing, mean daily blood glucose, and incidence of hypoglycemia.
RESULTS: Use of BBC insulin regimen increased from 10.6% to 27.5% after (P<0.001) order set implementation. Use of oral anti-hyperglycemic agents decreased from 24.1% to 14.9% after implementation (P=0.006). Hemoglobin A1c testing rose from 50% to 62.3% after (P=0.003). Mean daily blood glucose improved, with an estimated mean (95% confidence interval) difference of 14.4 (2.2 - 26.5) mg/dl over hospital days 3 through 9 (P=0.02). There was no significant change in the incidence of moderate or severe hypoglycemia.
CONCLUSIONS: Implementation of hospital-wide human insulin order sets led to improvements in prescribing practices and blood glucose control without increasing the incidence of hypoglycemia. These order sets may be useful for facilities limited by formulary and cost considerations to older human insulins.
PMID: 26121450 [PubMed - as supplied by publisher]