title: EFFECTIVENESS OF INPATIENT INSULIN ORDER SETS USING HUMAN INSULINS IN NONCRITICALLY ILL PATIENTS IN A RURAL HOSPITAL.
abstract: OBJECTIVE
  Recent guidelines recommend a physiologic approach to non-intensive care unit (ICU) inpatient glucose management utilizing basal-bolus with correctional (BBC) insulin over traditional sliding-scale insulin monotherapy. Unfortunately, few studies exist using a BBC approach restricted to human insulins (regular and neutral protamine Hagedorn [NPH]). This study evaluated changes in provider prescribing patterns, effects on blood glucose, and safety with implementation of hospital order sets for BBC using human insulins.
  
  
  METHODS
  Order sets were developed for non-ICU inpatients, consisting of basal, prandial, and correctional insulin using NPH and regular human insulins. Evaluation compared a 4-month period before (admissions, n = 274) with a 4-month period after order set availability (n = 302). Primary outcome was change in insulin prescribing patterns. Secondary outcomes included use of nonpreferred diabetes treatments, hemoglobin A1c testing, mean daily blood glucose, and incidence of hypoglycemia.
  
  
  RESULTS
  Use of BBC insulin regimen increased from 10.6 to 27.5% after order set implementation (P<.001). Use of oral antihyperglycemic agents decreased from 24.1 to 14.9% after implementation (P = .006). Hemoglobin A1c testing rose from 50.0 to 62.3% after (P = .003). Mean daily blood glucose improved, with an estimated mean difference of 14.4 mg/dL (95% confidence interval, 2.2 to 26.5 mg/dL) over hospital days 3 through 9 (P = .02). There was no significant change in the incidence of moderate or severe hypoglycemia.
  
  
  CONCLUSIONS
  Implementation of hospital-wide human insulin order sets led to improvements in prescribing practices and blood glucose control, without increasing the incidence of hypoglycemia. These order sets may be useful for facilities limited by formulary and cost considerations to the use of older human insulins.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Valgardson
authors.forename: Maricruz
authors.initials: M
authors.lastname: Merino
authors.forename: Jamie
authors.initials: J
authors.lastname: Redgrave
authors.forename: James I
authors.initials: JI
authors.lastname: Hudson
authors.forename: Margo S
authors.initials: MS
authors.lastname: Hudson
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007297:Inpatients / Q000706:statistics & numerical data*; D061386:Insulin, Regular, Human / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*
chemical_list: D007004:Hypoglycemic Agents; D061386:Insulin, Regular, Human