Funding organizations had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of data; or preparation, review, or approval of the manuscript. JLS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Inpatient management of diabetes and hyperglycemia among general medicine patients at a large teaching hospital†
Article first published online: 2 JUN 2006
Copyright © 2006 Society of Hospital Medicine
Journal of Hospital Medicine
Volume 1, Issue 3, pages 145–150, May/June 2006
How to Cite
Schnipper, J. L., Barsky, E. E., Shaykevich, S., Fitzmaurice, G. and Pendergrass, M. L. (2006), Inpatient management of diabetes and hyperglycemia among general medicine patients at a large teaching hospital. J. Hosp. Med., 1: 145–150. doi: 10.1002/jhm.96
- Issue published online: 2 JUN 2006
- Article first published online: 2 JUN 2006
- Manuscript Accepted: 3 FEB 2006
- Manuscript Revised: 2 FEB 2006
- Manuscript Received: 21 DEC 2005
- Division of General Medicine at Brigham and Women's Hospital
- National Heart, Lung, and Blood Institute. Grant Number: HL072806
- Novo Nordisk
- Kos Pharmaceuticals
- diabetes mellitus;
- hyperglycemia management;
- outcomes measurement;
- care standardization
Because of the relationship between inpatient hyperglycemia and adverse patient outcomes, current guidelines recommend glucose levels less than 180 mg/dL in the non-ICU inpatient setting and the use of effective insulin protocols for appropriate patients.
To determine the current state of glucose management on an academic hospitalist service and the relationship between insulin-ordering practices and glycemic control.
Prospective cohort study.
Hospitalist-run general medicine service of an academic teaching hospital.
107 consecutive patients with diabetes mellitus or inpatient hyperglycemia.
We collected data on up to 4 bedside glucose measurements per day, detailed clinical information, and all orders related to glucose management. The primary outcomes were rate of hyperglycemia (glucose > 180 mg/dL) per patient and mean glucose level per patient-day.
The mean rate of hyperglycemia was 31% of measurements per patient. Basal insulin was ordered for 43% of patients, and scheduled rapid- or short-acting insulin was ordered for 4% of patients. Sixty-five percent of patients who had at least 1 episode of hyper- or hypoglycemia had no change made to any insulin order during the first 5 days of the hospitalization. When adjusted for clinical factors, the use of sliding-scale insulin by itself was associated with a 20 mg/dL higher mean glucose level per patient-day.
Management of diabetes and hyperglycemia on a general medicine service showed several deficiencies in process and outcome. Possible targets for improvement include increased use of basal and nutritional insulin and daily insulin adjustment in response to hyperglycemia. Journal of Hospital Medicine 2006;3:145–150. © 2006 Society of Hospital Medicine.