Diabetes mellitus is a significant risk factor for morbidity and mortality in hospitalized patients. The purpose of this study is to evaluate the treatment of diabetic patients with regard to glucose control.
Methods
A retrospective inpatient chart review was performed on a sample of 209 patients. Those patients admitted to the hospital who had at least one fasting blood sugar greater than 110 mg/dL during the month of April 2008 were included. This study was approved by the Ohio University and Firelands Regional Medical Center Institutional Review Boards.
Results
Fifty-three percent of hyperglycemic patients had no diagnosis of diabetes before admission. Of those found to be hyperglycemic, no glycemic treatment was offered in 51% of patients. Of the patients who received insulin therapy, almost half (45%) received sliding-scale insulin coverage, with no other treatment offered. Insulin was not titrated in 85% of patients throughout their stay. The mean glucose reading that triggered a change in treatment was 265 mg/dL. Mean average glucose excursion throughout the day was 87 mg/dL.
Conclusion
Hyperglycemic management in the inpatient setting has significant room for improvement. Insulin use was titrated too infrequently and often too late to improve patient care. Despite its record of ineffectiveness, the majority of patients in our study received sliding scale insulin as their only insulin therapy. Further research is needed to explore morbidity and mortality associated with the use of sliding scale insulin versus basal-bolus insulin, with the goal of achieving improved postprandial glucose control.
ABSTRACT