Comparison of management of in-patient hyperglycaemia by standard specialist care vs basal-bolus-booster insulin in a tertiary referral hospital — ASN Events
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  3. Comparison of management of in-patient hyperglycaemia by standard specialist care vs basal-bolus-booster insulin in a tertiary referral hospital

Comparison of management of in-patient hyperglycaemia by standard specialist care vs basal-bolus-booster insulin in a tertiary referral hospital (#346)

Lili Yuen 1 2 , Augusta Ho 3 , Ahmed Hussein 4 , Andrew G Lin 5 , John Moutzouris 5 , Alyson France 2 , Namson S Lau 1 2 6
  1. Diabetes & Endocrine Service, Liverpool Hospital, Liverpool, NSW, Australia
  2. LIVEDIAB, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
  3. Faculty of Medicine, UNSW, Kensington, NSW, Australia
  4. Department of Endocrinology, Blacktown Hospital, Blacktown, NSW, Australia
  5. Department of Medicine, Liverpool Hospital, Liverpool, NSW, Australia
  6. Faculty of Medicine, UNSW, Kensington, NSW, Australi

 

Introduction

Hyperglycaemia is a significant issue in people with diabetes (DM) especially when unwell requiring hospitalisation. Poor in-patient glycaemic control is associated with increased morbidity and mortalitya. Knowledge by non-specialist teams regarding DM is frequently poor hence management is often facilitated via consultation with endocrine teams (ET). We previously reported that for people with T2DM and admitted to hospital, use of a standardised insulin protocol involving basal-bolus-booster doses (3BL) provided superior glycaemic outcomes compared to non ET managementb. However it is unknown whether an insulin protocol (3BL) is superior to regular ET management of in-patient hyperglycaemia.

Method

Blood glucose levels (BGL) and actions taken to correct dysglycaemia 5 days prior to and post ET consultations for inpatient hyperglycaemia were collected for 12 months preceding and following the implementation of the 3BL protocol.

Results

Data from 118 pre-3BL and 96 post-3BL ET consultations was analysed. The pre and post 3BL five day BGLs (mean ± SD) were not significantly different [pre 11.9 ± 8.1 mmol/L v post 10.9 ± 2.8 mmol/L, p=0.2], nor were the frequency of BGLs>14mmol/L (24% v 23%) nor the frequency of BGLs <4mmol/L (4% v. 3%). Of the actions taken by the ET pre protocol, 30% involved regular insulin, which was titrated in 18% of cases; 15% used stat or supplemental insulin and 20% made changes to oral hypoglycaemic agents. From post-3BL cases, 25% involved insulin titration and <10% cases either used stat insulin or adjusted oral agents.

Conclusion

Compared to specialist management of in-patient hyperglycaemia, a standardised insulin protocol was as effective while involving fewer actions. This suggests that a well-designed and easy to administer insulin protocol for in-patient hyperglycaemia could be considered as a suitable tool for use by non endocrine teams, hereby providing more timely management of this important issue.

 

 

  1. Clement S, Braithwaite SS, Magee MF et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care 2004; 27: 553‐591.
  2. Augusta Ho, Vincent M Wong, Namson S Lau. Comparing a basal-bolus booster insulin regimen to standard care for in-patient hyperglycaemia in a major tertiary referral centre. ADS-ASM 2015 Abstract
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