Management of inpatient hyperglycemia: assessing perceptions and barriers to care among resident physicians.
OBJECTIVE
To develop insight into resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal management.


METHODS
As part of a planned educational program, a questionnaire was designed and administered to determine the opinions of residents about the importance of inpatient glucose control, their perceptions about what glucose ranges were desirable, and the problems they encountered when trying to manage hyperglycemia in hospitalized patients.


RESULTS
Of 70 resident physicians from various services, 52 completed the survey (mean age, 31 years; 48% men; 37% in first year of residency training). Most respondents indicated that glucose control was "very important" in critically ill and perioperative patients but only "somewhat important" in non-critically ill patients. Most residents indicated that they would target a therapeutic glucose range within the recommended levels in published guidelines. Most residents also said they felt "somewhat comfortable" managing hyperglycemia and hypoglycemia and using subcutaneous insulin therapy, whereas most residents (48%) were "not at all comfortable" with use of intravenous administration of insulin. In general, respondents were not very familiar with existing institutional policies and preprinted order sets relating to glucose management. The most commonly reported barrier to management of inpatient hyperglycemia was lack of knowledge about appropriate insulin regimens and how to use them. Anxiety about hypoglycemia was only the third most frequent concern.


CONCLUSIONS
Most residents acknowledged the importance of good glucose control in hospitalized patients and chose target glucose ranges consistent with existing guidelines. Lack of knowledge about insulin treatment options was the most commonly cited barrier to ideal management. Educational programs should emphasize inpatient treatment strategies for glycemic control.
Cook
Curtiss B
CB
Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, Arizona 85259, USA.
McNaughton
Dean A
DA
Braddy
Cathleen M
CM
Jameson
Kimberly A
KA
Roust
Lori R
LR
Smith
Steven A
SA
Roberts
Daniel L
DL
Thomas
Stephen L
SL
Hull
Bryan P
BP
D000328:Adult; D001291:Attitude of Health Personnel; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy* / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007297:Inpatients; D007328:Insulin / Q000627:therapeutic use; D007396:Internship and Residency; D008297:Male; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin