Long-term improvements in insulin prescribing habits and glycaemic control in medical inpatients associated with the introduction of a standardized educational approach.
BACKGROUND
We carried out an educational strategy to increase physician adherence to 8 recommendations for inpatient evaluation and management of diabetes endorsed by the American Diabetes Association.


METHODS
We evaluated physician attitude, barriers and facilitators to incorporate the proposed recommendations into clinical practice. We analyzed the impact of the educational strategy on process-of-care and outcome variables in 138 patients with type 2 diabetes discharged from the internal medicine department before the intervention, at 3-month and at 9-month after the intervention.


RESULTS
After the educational intervention there was a high motivation of physicians to adhere to the proposed recommendations. The intervention caused a significant reduction of insulin administered by sliding scale (50% vs. 7% vs. 3%, P=0.000), and in the median pre-discharge glycaemic values (185 mg/dL vs. 153 mg/dL vs. 161 mg/dL, P=0.005), in the three periods, respectively. The use basal-bolus-correction insulin dosage increased in postintervention periods (17% vs. 85% vs. 99%, P=0.004). Hypoglycaemia (glycaemia <60 mg/dL) episodes were similar among the three periods (0.30% vs. 0.70% vs. 1.07%, P=0.10). The intervention required improvements to promote haemoglobin(A1c) ordering on admission and diabetes intensification therapy at discharge when needed.


CONCLUSIONS
Our educational strategy improved physician adoption of practice guidelines.
Ena
Javier
J
Hospital Marina Baixa, Department of Internal Medicine, Villajoyosa, Alicante, Spain. ena_jav@gva.es
Casañ
Rosa
R
Lozano
Teresa
T
Leach
Angela
A
Algado
Josep Tomás
JT
Navarro-Diaz
Francisco José
FJ
D001291:Attitude of Health Personnel; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000534:rehabilitation*; D011307:Drug Prescriptions / Q000592:standards*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D010353:Patient Education as Topic; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D013030:Spain
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin