Overcoming clinical inertia in the management of postoperative patients with diabetes.
OBJECTIVE
To assess the impact of an intervention designed to increase basal-bolus insulin therapy administration in postoperative patients with diabetes mellitus.


METHODS
Educational sessions and direct support for surgical services were provided by a nurse practitioner (NP). Outcome data from the intervention were compared to data from a historical (control) period. Changes in basal-bolus insulin use were assessed according to hyperglycemia severity as defined by the percentage of glucose measurements >180 mg/dL.


RESULTS
Patient characteristics were comparable for the control and intervention periods (all P≥.15). Overall, administration of basal-bolus insulin occurred in 9% (8/93) of control and in 32% (94/293) of intervention cases (P<.01). During the control period, administration of basal-bolus insulin did not increase with more frequent hyperglycemia (P = .22). During the intervention period, administration increased from 8% (8/96) in patients with the fewest number of hyperglycemic measurements to 60% (57/95) in those with the highest frequency of hyperglycemia (P<.01). The mean glucose level was lower during the intervention period compared to the control period (149 mg/dL vs. 163 mg/dL, P<.01). The proportion of glucose values >180 mg/dL was lower during the intervention period than in the control period (21% vs. 31% of measurements, respectively, P<.01), whereas the hypoglycemia (glucose >70 mg/dL) frequencies were comparable (P = .21).


CONCLUSIONS
An intervention to overcome clinical inertia in the management of postoperative patients with diabetes led to greater utilization of basal-bolus insulin therapy and improved glucose control without increasing hypoglycemia. These efforts are ongoing to ensure the delivery of effective inpatient diabetes care by all surgical services.
Department of Surgery, Mayo Clinic Hospital, Phoenix, Arizona.
Heidi A
HA
Apsey
Department of Surgery, Mayo Clinic Hospital, Phoenix, Arizona.
Kathryn E
KE
Coan
Department of Information Technology, Mayo Clinic Hospital, Phoenix, Arizona.
Janna C
JC
Castro
Division of Planning Services and Practice Analysis, Mayo Clinic, Scottsdale, Arizona.
Kimberly A
KA
Jameson
Department of Surgery, Mayo Clinic Hospital, Phoenix, Arizona.
Richard T
RT
Schlinkert
Division of Endocrinology, Mayo Clinic, Scottsdale, Arizona Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Scottsdale, Arizona.
Curtiss B
CB
Cook
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care
D001786:Blood Glucose; D007328:Insulin