title: Assessment of an educational intervention in the management of non-critical inpatient glycemic control.
abstract: In hospitalized diabetic patients, the recommended insulin therapy is basal bolus plus correction-dose regimen instead of sliding-scale insulin. The purpose of this study was to evaluate the effect of the implementation of a new protocol based on basal bolus therapy on managing diabetes in a university hospital setting. We performed a cross-sectional study before and 12 months after a 4-month intervention period to implement a basal bolus regimen in hospitalized patients. Non-critical patients admitted into the hospital for at least 72 h were included. Changes in prescribing habits, glucose control and incidence of hypoglycemia were evaluated. An increase in the use of the new protocol and a decrease in sliding scale were observed after the intervention. In the pre-intervention group, a total of 59.2% glucose readings were between 70 and 180 mg/dL versus 57.1% after the intervention, without observing statistical differences. Significant reductions in hypoglycemia between pre- and post-intervention (13.04 vs. 4.08%, p = 0.0215) were observed. The percentage of hospitalized diabetic patients who had HbA1c was 10.43 and 4.08% in pre- and post-intervention phases, respectively. The protocol showed beneficial outcomes in terms of fewer hypoglycemia episodes and reflected a change in prescription habits, but it did not improve glycemic control. Furthermore, the percentage of patients who had an HbA1c test during their hospitalization remained very low after the intervention. This fact may seriously limit the correct management of hyperglycemia after the hospital discharge.
authors.affiliation: Department of Internal Medicine, Hospital Regional Universitario de Malaga, Avda. Carlos Haya s/n, 29010, Málaga, Spain, ricardogomezhuelgas@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Gomez-Huelgas
authors.forename: M D
authors.initials: MD
authors.lastname: Lopez-Carmona
authors.forename: S
authors.initials: S
authors.lastname: Jansen-Chaparro
authors.forename: B
authors.initials: B
authors.lastname: Sobrino
authors.forename: M
authors.initials: M
authors.lastname: Chaves
authors.forename: P
authors.initials: P
authors.lastname: Martin-Gallardo
authors.forename: C
authors.initials: C
authors.lastname: Garcia-Fernandez
authors.forename: M R
authors.initials: MR
authors.lastname: Bernal-Lopez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism; D019468:Disease Management; D004358:Drug Therapy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000378:metabolism; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human