title: Implementation of subcutaneous insulin protocol for non-critically ill hospitalized patients in andalusian tertiary care hospitals.
abstract: BACKGROUND
  In 2009, the Andalusian Society of Endocrinology and Nutrition designed a protocol for subcutaneous insulin treatment in hospitalized non-critically ill patients (HIP).
  
  
  OBJECTIVE
  To analyze implementation of HIP at tertiary care hospitals from the Andalusian Public Health System.
  
  
  METHODS
  A descriptive, multicenter study conducted in 8 tertiary care hospitals on a random sample of non-critically ill patients with diabetes/hyperglycemia (n=306) hospitalized for ≥48 hours in 5 non-surgical (SM) and 2 surgical (SQ) departments. Type 1 and other specific types of diabetes, pregnancy and nutritional support were exclusion criteria.
  
  
  RESULTS
  288 patients were included for analysis (62.5% males; 70.3±10.3 years; 71.5% SM, 28.5% SQ). A scheduled subcutaneous insulin regimen based on basal-bolus-correction protocol was started in 55.9% (95%CI: 50.5-61.2%) of patients, 63.1% SM vs. 37.8% SQ (P<.05). Alternatives to insulin regimen based on basal-bolus-correction included sliding scale insulin (43.7%), diet (31.3%), oral antidiabetic drugs (17.2%), premixed insulin (1.6%), and others (6.2%). For patients previously on oral antidiabetic drugs, in-hospital insulin dose was 0.32±0.1 IU/kg/day. In patients previously on insulin, in-hospital insulin dose was increased by 17% [-13-53], and in those on insulin plus oral antidiabetic drugs, in-hospital insulin dose was increased by 26.4% [-6-100]. Supplemental insulin doses used for<40 IU/day and 40-80 IU/day were 72.2% and 56.7% respectively. HbA1c was measured in 23.6% of patients (95CI%: 18.8-28.8); 27.7% SM vs. 13.3% SQ (P<.05).
  
  
  CONCLUSIONS
  Strategies are needed to improve implementation of the inpatient subcutaneous insulin protocol, particularly in surgical departments. Sliding scale insulin is still the most common alternative to insulin regimen based on basal-bolus-correction scheduled insulin. Metabolic control assessment during hospitalization should be encouraged.
authors.affiliation: Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Instituto de Investigación Biomédica de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España. Electronic address: masuncion.martinez.sspa@juntadeandalucia.es.
authors.forename: María Asunción
authors.initials: MA
authors.lastname: Martínez-Brocca
authors.affiliation: Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, España.
authors.forename: Cristóbal
authors.initials: C
authors.lastname: Morales
authors.affiliation: Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Juan Ramón Jiménez, Huelva, España.
authors.forename: Pilar
authors.initials: P
authors.lastname: Rodríguez-Ortega
authors.affiliation: Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Instituto de Investigación Biomédica de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España.
authors.forename: Beatriz
authors.initials: B
authors.lastname: González-Aguilera
authors.affiliation: Unidad de Gestión Clínica de Endocrinología y Nutrición, Complejo Hospitalario de Jaén, Jaén, España.
authors.forename: Cristina
authors.initials: C
authors.lastname: Montes
authors.affiliation: Unidad de Gestión Clínica Intercentros, Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: Natalia
authors.initials: N
authors.lastname: Colomo
authors.affiliation: Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de las Nieves, Granada, España.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Piédrola
authors.affiliation: Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen de Valme, Sevilla, España.
authors.forename: Mariola
authors.initials: M
authors.lastname: Méndez-Muros
authors.affiliation: Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, España.
authors.forename: Isabel
authors.initials: I
authors.lastname: Serrano
authors.affiliation: Unidad de Gestión Clínica Intercentros, Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: Maria Soledad
authors.initials: MS
authors.lastname: Ruiz de Adana
authors.affiliation: Unidad de Gestión Clínica de Endocrinología y Nutrición, Complejo Hospitalario de Jaén, Jaén, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen de Valme, Sevilla, España.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Fernández
authors.affiliation: Plan Integral de Diabetes, Unidad de Gestión Clínica Intercentros de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Cádiz, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Aguilar
authors.affiliation: Unidad de Gestión Clínica Provincial de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Instituto de Investigación Biomédica de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España.
authors.forename: Domingo
authors.initials: D
authors.lastname: Acosta
authors.affiliation: Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Palomares
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence; D006748:Hospital Departments; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011897:Random Allocation; D013030:Spain; D062606:Tertiary Care Centers / Q000458:organization & administration*
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Diabetes mellitus; Hospitalización; Inpatients; Insulin; Insulina