title: [Evaluation of the effectiveness of a protocol designed to improve glycemic control in hospitalized internal medicine patients with hyperglycemia].
abstract: BACKGROUND
  Our aims were to assess the effectiveness of a diabetes (DM) management protocol to increase scheduled insulin therapy and to improve glycemic inpatient control.
  
  
  METHODS
  We designed an analytical retrospective cohort study comparing 2 groups of medical services hospitalized patients with a primary of secondary discharge diagnosis of DM, before (group PRE) and after (group POS) the delivery of a DM management protocol. We analyzed the quality of attention by process indicators (cumulative probability of receive scheduled insulin therapy, evaluated with Kaplan-Meier analysis) and result indicators (adjusted glucose differences (group POS - group PRE), evaluated with multivariate regression models).
  
  
  RESULTS
  A number of patients (355) were included (228 group PRE and 127 group POS). The median time to scheduled insulin regimen beginning was 1 (CI 95%: 0-2.5) day in group POS and 4 (CI 95%: 2-6) days in group PRE (p=0.056). First 48 hours mean glucose in patients without scheduled insulin therapy was lower in group POS than in group PRE (163.9 versus 186.7 mg/dl; p=0.025). The first 24 hours mean glucose was significantly lower in patients of group POS, with a difference between both groups of -24.8 mg/dl (CI 95%: -40.5-(-9); p=0.002). Stratified analysis showed statistically significant mean in-hospital glucose difference only in the nothing by mouth situation (-29.8 mg/dl; CI 95%: -58.9-(-0.6); p=0.045).
  
  
  CONCLUSIONS
  The delivery of an institutional protocol can improve hospitalized DM patients management quality.
authors.affiliation: Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, danielsaenzabad@hotmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Sáenz Abad
authors.forename: J A
authors.initials: JA
authors.lastname: Gimeno-Orna
authors.forename: B
authors.initials: B
authors.lastname: Sierra-Bergua
authors.forename: M C
authors.initials: MC
authors.lastname: Lahoza-Pérez
authors.forename: J I
authors.initials: JI
authors.lastname: Pérez-Calvo
mesh_terms: D001786:Blood Glucose; D015331:Cohort Studies; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007297:Inpatients; D007328:Insulin / Q000627:therapeutic use*; D007388:Internal Medicine; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin