TY - JOUR
T1 - Inpatient management of hyperglycemia
T2 - The northwestern experience
AU - DeSantis, Anthony J.
AU - Schmeltz, Lowell R.
AU - Schmidt, Kathleen
AU - O'Shea-Mahler, Eileen
AU - Rhee, Connie
AU - Wells, Angela
AU - Brandt, Stephen
AU - Peterson, Sara
AU - Molitch, Mark E.
PY - 2006
Y1 - 2006
N2 - Objective: To describe a novel method of safe and effective intensive management of inpatient hyperglycemia with use of cost-effective protocols directed by a glucose management service (GMS). Methods: An intravenous insulin protocol was designed to achieve a glycemic target of 80 to 110 mg/dL. When stable inpatients were transferred from the intravenous protocol to a subcutaneous insulin protocol, which consisted of basal long-acting and prandial and supplemental rapid-acting insulins, the blood glucose target was 80 to 150 mg/dL. Glucose levels were reviewed by the GMS at least daily for protocol adjustments, when necessary. Results: The intravenous insulin protocol was used in 276 patients, and 4,058 capillary blood glucose levels were recorded. Glycemic target levels (80 to 110 mg/dL) were achieved, on average, 10.6 ± 5.2 hours after initiation of insulin drip therapy. The mean capillary blood glucose level during the study interval was 135.3 ± 49.9 mg/dL. Hypoglycemia (≤60 mg/dL) was recorded in 1.5% of glucose values, and hyperglycemia (≥400 mg/dL) was recorded in only 0.06%. The subcutaneous insulin protocol was used in 922 patients, and 18,067 capillary glucose levels were documented. The mean blood glucose level was 145.6 ± 55.8 mg/dL during the study period. The blood glucose target of 80 to 150 mg/dL was achieved in 58.6%, whereas 74.3% of glycemic values were in the clinically acceptable range (80 to 180 mg/dL). Hypoglycemia (≤60 mg/dL) occurred in 1.3% of capillary blood glucose values, and hyperglycemia (≥400 mg/dL) occurred in 0.4% of values. Conclusion: Validated protocols dedicated to the achievement of strict glycemic goals were implemented by a GMS and resulted in substantial improvements in glycemic control on the surgical inpatient services, with a reduced frequency of hypoglycemia. The protocols and the GMS have been well received by the inpatient nursing and surgical staff members, and all of this has been done in a cost-effective manner.
AB - Objective: To describe a novel method of safe and effective intensive management of inpatient hyperglycemia with use of cost-effective protocols directed by a glucose management service (GMS). Methods: An intravenous insulin protocol was designed to achieve a glycemic target of 80 to 110 mg/dL. When stable inpatients were transferred from the intravenous protocol to a subcutaneous insulin protocol, which consisted of basal long-acting and prandial and supplemental rapid-acting insulins, the blood glucose target was 80 to 150 mg/dL. Glucose levels were reviewed by the GMS at least daily for protocol adjustments, when necessary. Results: The intravenous insulin protocol was used in 276 patients, and 4,058 capillary blood glucose levels were recorded. Glycemic target levels (80 to 110 mg/dL) were achieved, on average, 10.6 ± 5.2 hours after initiation of insulin drip therapy. The mean capillary blood glucose level during the study interval was 135.3 ± 49.9 mg/dL. Hypoglycemia (≤60 mg/dL) was recorded in 1.5% of glucose values, and hyperglycemia (≥400 mg/dL) was recorded in only 0.06%. The subcutaneous insulin protocol was used in 922 patients, and 18,067 capillary glucose levels were documented. The mean blood glucose level was 145.6 ± 55.8 mg/dL during the study period. The blood glucose target of 80 to 150 mg/dL was achieved in 58.6%, whereas 74.3% of glycemic values were in the clinically acceptable range (80 to 180 mg/dL). Hypoglycemia (≤60 mg/dL) occurred in 1.3% of capillary blood glucose values, and hyperglycemia (≥400 mg/dL) occurred in 0.4% of values. Conclusion: Validated protocols dedicated to the achievement of strict glycemic goals were implemented by a GMS and resulted in substantial improvements in glycemic control on the surgical inpatient services, with a reduced frequency of hypoglycemia. The protocols and the GMS have been well received by the inpatient nursing and surgical staff members, and all of this has been done in a cost-effective manner.
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U2 - 10.4158/EP.12.5.491
DO - 10.4158/EP.12.5.491
M3 - Article
C2 - 17002924
AN - SCOPUS:33845803325
SN - 1530-891X
VL - 12
SP - 491
EP - 505
JO - Endocrine Practice
JF - Endocrine Practice
IS - 5
ER -
