title: The GesTIO protocol experience: safety of a standardized order set for subcutaneous insulin regimen in elderly hospitalized patients.
abstract: BACKGROUND
  In non-critical hospitalized patients with diabetes mellitus, guidelines suggest subcutaneous insulin therapy with basal-bolus regimen, even in old and vulnerable inpatients.
  
  
  OBJECTIVE
  To evaluate safety, efficacy, and benefit on clinical management of the GesTIO protocol, a set of subcutaneous insulin administration rules, in old and vulnerable non-ICU inpatients.
  
  
  METHODS
  Retrospective, observational study. Patients admitted to Geriatric Clinic of Padua were studied. 88 patients matched the inclusion criteria: type 2 diabetes or hospital-related hyperglycemia, ≥65 years, regular measurements of capillary glycemia, and basal-bolus subcutaneous insulin regimen managed by "GesTIO protocol" for five consecutive days.
  
  
  METHODS
  ratio of patients with blood glucose (BG) <3.9 mmol/l; number of BG per patient in target range (5-11.1 mmol/l); daily mean BG; and calls to physicians for adjusting insulin therapy.
  
  
  RESULTS
  Mean age was 82 ± 7 years. 9.1% patients experienced mild hypoglycaemia, and no severe hypoglycaemia was reported. The median number of BG per patients in target range increased from 2.0 ± 2 to 3.0 ± 2 (p < 0.001). The daily mean BG decreased from 11.06 ± 3.03 to 9.64 ± 2.58 mmol/l (-12.8%, p < 0.005). The mean number of calls to physicians per patient decreased from 0.83 to 0.45 (p < 0.05).
  
  
  CONCLUSIONS
  Treatment with GesTIO protocol allows a safe and effective treatment even in very old and vulnerable inpatients with a faster management insulin therapy.
authors.affiliation: Department of Medicine (DIMED), Clinica Geriatrica, University of Padua, Via Giustiniani, 2, 35124, Padua, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Franchin
authors.affiliation: Malattie del Metabolismo, Department of Medicine (DIMED), University of Padua, Via Giustiniani, 2, 35124, Padua, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Maran
authors.affiliation: Malattie del Metabolismo, Department of Medicine (DIMED), University of Padua, Via Giustiniani, 2, 35124, Padua, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Bruttomesso
authors.affiliation: Department of Medicine (DIMED), Clinica Geriatrica, University of Padua, Via Giustiniani, 2, 35124, Padua, Italy.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Corradin
authors.affiliation: Department of Medicine (DIMED), Clinica Geriatrica, University of Padua, Via Giustiniani, 2, 35124, Padua, Italy. rossi.francesco.0884@gmail.com.
authors.forename: Francesco
authors.identifier: http://orcid.org/0000-0002-1730-4751
authors.initials: F
authors.lastname: Rossi
authors.affiliation: Department of Medicine (DIMED), Clinica Geriatrica, University of Padua, Via Giustiniani, 2, 35124, Padua, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Zanatta
authors.affiliation: Medicina Generale, Department of Medicine (DIMED), University of Padua, Via Giustiniani, 2, 35124, Padua, Italy.
authors.forename: Gian-Maria
authors.initials: GM
authors.lastname: Barbato
authors.affiliation: Department of Medicine (DIMED), Clinica Medica 3^, University of Padua, Via Giustiniani, 2, 35124, Padua, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Sicolo
authors.affiliation: Department of Medicine (DIMED), Clinica Geriatrica, University of Padua, Via Giustiniani, 2, 35124, Padua, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Manzato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D005853:Geriatrics / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000008:administration & dosage; D008297:Male; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine
keywords: Diabetes mellitus; Geriatric medicine; GesTIO; Insulin management protocol; Insulin therapy; Vulnerable inpatients