title: Implementation of a dedicated hospital subcutaneous insulin prescription chart: effect on glycaemic control.
abstract: A dedicated subcutaneous insulin prescription chart incorporating glucose monitoring results, forced functions, and management guidelines was introduced to facilitate better hospital diabetes control. Point of care capillary blood glucose monitoring charts for 99 people with diabetes from the period before the introduction of the new chart, and 106 after its introduction were reviewed. A total of 12,649 blood glucose levels (BGLs) were collected for glucometric analysis. Following the introduction of the chart, there was an increase in the number of BGLs performed daily from 4.5 ± 1.2 to 4.9 ± 1.3 (p = 0.05). There was an increase in the proportion of BGLs within the ideal range of 4-9.9 mmol/L (51.8% vs. 54.1%, p = 0.01). There was a reduction in hypoglycaemic events (proportion of BGLs <4 mmol/L in the whole population decreased from 5.2% to 3.4% (p < 0.001), proportion of BGLs <4 mmol/L for each patient decreased from 5.6 ± 9.2% to 2.9 ± 5.4% (p = 0.01), proportion of days where patient had a BGL <4 mmol/L decreased from 17.6 ± 22.6% to 11.4 ± 18.8% (p = 0.03)), despite an increase in the use of supplemental insulin (14.2 ± 35.7 vs. 29.4 ± 51.4 u nits/patient, p = 0.02). We conclude that the use of a dedicated hospital subcutaneous insulin prescription chart can reduce hypoglycaemia and improve some measures of glycaemic control.
authors.affiliation: Department of Diabetes & Endocrinology, Westmead Hospital, Westmead, NSW 2145, Australia. wah@westgate.wh.usyd.edu.au
authors.forename: N W
authors.initials: NW
authors.lastname: Cheung
authors.forename: N
authors.initials: N
authors.lastname: Cinnadaio
authors.forename: A
authors.initials: A
authors.lastname: O'Neill
authors.forename: L
authors.initials: L
authors.lastname: Koller
authors.forename: H L
authors.initials: HL
authors.lastname: Pratt
authors.forename: C
authors.initials: C
authors.lastname: Zingle
authors.forename: D R
authors.initials: DR
authors.lastname: Chipps
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects*; D004333:Drug Administration Routes; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D007328:Insulin; D008297:Male; D008875:Middle Aged; D055656:Prescriptions / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin