Original Article

Analysis of a Guideline-Derived Resident Educational Program on Inpatient Glycemic Control

Authors: William B. Horton, MD, Andrew Q. Weeks, MD, J. Matthew Rhinewalt, MD, Richard D. Ballard, MD, Frederick H. Asher, MD

Abstract

Objectives: To determine the effects of a guideline-derived resident educational program on inpatient glycemic control and length of hospital stay (LOS).

Methods: We compared the following variables before and after resident education: percentage of patients on basal-plus-bolus regimens, mean fingerstick glucose (FSG), LOS, and rates of hypoglycemia (FSG <70 mg/dL) and severe hypoglycemia (FSG <40 mg/dL). A two-tailed t test was used for all continuous data and P < 0.05 was considered statistically significant.

Results: After education, more patients (23% vs 8%; P = 0.024) were placed on basal-plus-bolus regimens. We observed a decrease in mean FSG (158.7 mg/dL vs 165.1 mg/dL; P = 0.028) and LOS (5.03 days vs 6.98 days; P = 0.042). Rates of hypoglycemia (4.6% vs 1.5%; P < 0.001) and severe hypoglycemia (0.71% vs 0.24%; P = 0.089) increased.

Conclusions: Our resident educational program significantly increased the number of patients receiving guideline-based inpatient insulin therapy and was associated with a reduction in mean FSG and LOS. Rates of hypoglycemia showed a statistically significant increase, whereas rates of severe hypoglycemia did not. Larger multicenter studies with adjustment for potential confounders are needed to further assess the impact of educational interventions on inpatient glycemic control.

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References

1. Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract 2009;15:353-369.
 
2. Baldwin D, Villanueva G, McNutt R, et al. Eliminating inpatient sliding-scale insulin: a reeducation project with medical house staff. Diabetes Care 2005;28:1008-1011.
 
3. Umpierrez GE, Palacio A, Smiley D. Sliding scale insulin use: myth or insanity? Am J Med 2007;120:563-567.
 
4. Queale WS, Seidler AJ, Brancati FL. Glycemic control and sliding scale insulin use in medical inpatients with diabetes mellitus. Arch Intern Med 1997;157:545-552.
 
5. Gearhart JG, Duncan JL 3rd, Replogle WH, et al. Efficacy of sliding-scale insulin therapy: a comparison with prospective regimens. Fam Pract Res J 1994;14:313-322.
 
6. Sawin CT. Action without benefit. The sliding scale of insulin use. Arch Intern Med 1997;157:489.
 
7. Nau KC, Lorenzetti RC, Cucuzzella M, et al. Glycemic control in hospitalized patients not in intensive care: beyond sliding-scale insulin. Am Fam Physician 2010;81:1130-1135.
 
8. Schnipper JL, Barsky EE, Shaykevich S, et al. Inpatient management of diabetes and hyperglycemia among general medicine patients at a large teaching hospital. J Hosp Med 2006;1:145-150.
 
9. Ziemer DC, Doyle JP, Barnes CS, et al. An intervention to overcome clinical inertia and improve diabetes mellitus control in a primary care setting: Improving Primary Care of African Americans with Diabetes (IPCAAD) 8. Arch Intern Med 2006;166:507-513.
 
10. Rubin DJ, Moshang J, Jabbour SA. Diabetes knowledge: are resident physicians and nurses adequately prepared to manage diabetes? Endocr Pract 2007;13:17-21.
 
11. Tamler R, Green DE, Skamagas M, et al. Effect of case-based training for medical residents on inpatient glycemia. Diabetes Care 2011;34:1738-1740.
 
12. Magaji V, Johnston JM. Inpatient management of hyperglycemia and diabetes. Clin Diabetes 2011;29:36-39.
 
13. McEwan P, Larsen Thorsted B, Wolden M, et al. Healthcare resource implications of hypoglycemia-related hospital admissions and inpatient hypoglycemia: retrospective record-linked cohort studies in England. BMJ Open Diabetes Res Care 2015;3:e000057.
 
14. Brutsaert E, Carey M, Zonszein J. The clinical impact of inpatient hypoglycemia. J Diabetes Complications 2014;28:565-572.
 
15. Leite SA, Locatelli SB, Niece SP, et al. Impact of hyperglycemia on morbidity and mortality, length of hospitalization and rates of rehospitalization in a general hospital setting in Brazil. Diabetol Metab Syndr 2010;2:49.
 
16. Najarian J, Bartman K, Kaszuba J, et al. Improving glycemic control in the acute care setting through nurse education. J Vasc Nurs 2013;31:150-157.
 
17. Desimone ME, Blank GE, Virji M, et al. Effect of an educational Inpatient Diabetes Management Program on medical resident knowledge and measures of glycemic control: a randomized controlled trial. Endocr Pract 2012;18:238-249.