title: Benefits of a simple glycaemic protocol in an orthopaedic surgery ward: a randomized prospective study.
abstract: BACKGROUND
  Hyperglycaemia and diabetes mellitus are common in patients hospitalized in the orthopaedic surgery ward. However, glycaemic control obtained during hospitalization is often suboptimal. No method for achieving adequate glycaemic control in this population has been validated in an in-hospital setting.
  
  
  METHODS
  An intervention including an intensive subcutaneous insulin protocol in the orthopaedic department.
  
  
  METHODS
  All diabetic patients admitted to the Department of Orthopaedic Surgery were prospectively randomized during a 6-month period. One group (n = 30) received standard care with sliding scale insulin and the other group (n = 35) received the intervention protocol. During the intervention period, the staff was briefed on the importance of glucose monitoring and control. An intensive multiple-injection protocol consisting of four daily regular/neutral protamine hagedorn (NPH) insulin injections was initiated in diabetic patients. The programme was followed up by a consulting diabetologist.
  
  
  RESULTS
  Mean blood glucose levels throughout the hospitalization were 161.48 ± 3.8 mg/dL in the intervention group versus 175.29 ± 2.3 mg/dL in the control group (p < 0.0005). Hospitalization was shorter by 2 days in the intervention group (p < 0.05). The number of severe hyperglycaemic events (blood glucose level above 400 mg%) was significantly lower (p < 0.05) in the intervention group. There was no significant difference in the number of hypoglycaemic events.
  
  
  CONCLUSIONS
  The suggested four-step intervention regimen improved glycaemic control of hospitalized patients in the orthopaedic department and simplified the 'in-house' treatment of the diabetic patient. Hospital stays were reduced on average by two days (p < 0.05).
authors.affiliation: The Orthopedic Surgery Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel. schroeder.josh@gmail.com
authors.forename: Josh E
authors.initials: JE
authors.lastname: Schroeder
authors.forename: M
authors.initials: M
authors.lastname: Liebergall
authors.forename: I
authors.initials: I
authors.lastname: Raz
authors.forename: R
authors.initials: R
authors.lastname: Egleston
authors.forename: G
authors.initials: G
authors.lastname: Ben Sussan
authors.forename: A
authors.initials: A
authors.lastname: Peyser
authors.forename: R
authors.initials: R
authors.lastname: Eldor
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis / Q000187:drug effects; D002985:Clinical Protocols / Q000592:standards; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006282:Health Personnel / Q000193:education; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage*; D007336:Insulin, Isophane / Q000008:administration & dosage*; D008297:Male; D019637:Orthopedic Procedures; D010353:Patient Education as Topic; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D007336:Insulin, Isophane