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Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Research Article

Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

Author(s): Ghada El Khoury*, Hanine Mansour, Wissam K. Kabbara, Nibal Chamoun, Nadim Atallah and Pascale Salameh

Volume 15, Issue 2, 2019

Page: [133 - 140] Pages: 8

DOI: 10.2174/1573399814666180119142254

Price: $65

Abstract

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions.

Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients.

Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence.

Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%).

Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

Keywords: Diabetes, hyperglycemia management, hospitalized patients, Lebanon, tertiary care, non-critically ill.

[1]
International Diabetes Federation. 2016. Available at:. https://www.idf.org/membership/mena/lebanon [Accessed on: March 10, 2016].
[2]
American Diabetes Association: Standards of Medical Care in Diabetes. 2016. Available at:. http://care.diabetesjournals.org/site/ misc/2016-Standards-of-Care.pdf [Accessed on: March 10, 2016].
[3]
Inzucchi S. Management of hyperglycemia in the hospital setting. N Engl J Med 2006; 355(18): 1903-11.
[4]
Tomky D. Detection, prevention, and treatment of hypoglycemia in the hospital. Diabetes Spectr 2005; 18(1): 39-44.
[5]
Moghissi E, Korytkowski M, DiNardo M, et al. American association of clinical endocrinologists and American diabetes association consensus statement on inpatient glycemic control. Diabetes Care 2009; 32(6): 1119-31.
[6]
Browning L, Dumo P. Sliding-scale insulin: an antiquated approach to glycemic control in hospitalized patients. Am J Health Syst Pharm 2004; 61(15): 1611-4.
[7]
Said E, Farid S, Sabry N, and Fawzi M. Comparison on efficacy and safety of three inpatient insulin regimens for management of non-critical patients with type 2 diabetes. Pharmacol Pharm 2013; (4): 556-65.
[8]
Arif S, Escano A. Barriers to implementing an insulin order form in a non icu medical unit. P&T 2012; 35(1): 30-42.
[9]
Umpierrez G, Smiley D, Zisman A, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of diabetes (RABBIT 2 trial). Diabetes Care 2007; 30(9): 2181-6.
[10]
Umpierrez G, Smiley D, Jacob S, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (Rabbit 2 Surgery). Diabetes Care 2011; 34: 256-61.
[11]
Chen H, Steinke D, Karounos D, et al. Intensive insulin protocol implementation and outcomes in the medical and surgical wards at a veteran’s affairs medical center. Ann Pharmacother 2010; 44(2): 249-56.
[12]
Patel G, Roderman N, Lee K, et al. Sliding scale versus tight glycemic control in the noncritically ill at a community hospital. Ann Pharmacother 2009; 43: 1774-80.
[13]
Perera N, Harding A, Molyneaux L, et al. Triple-B (basal-bolus-booster) subcutaneous insulin regimen: A pragmatic approach to managing hospital inpatient hyperglycaemia. Pract Diabetes 2011; 28(6): 266-9.
[14]
Schnipper J, Barsksy E, Shaykevich S, et al. Inpatient management of diabetes and hyperglycemia among general medicine patients at a large teaching hospital. J Hosp Med 2006; 1(3): 145-50.
[15]
Vallis M, Jones A, Pouwer F. Managing hypoglycemia in diabetes may be more fear management than glucose management: A practical guide for diabetes care providers. Curr Diabetes Rev 2014; 10(6): 364-70.
[16]
Cornish W. Safe and appropriate use of insulin and other antihyperglycemic agents in hospital. Can J Diabetes 2014; 38(2): 94-100.
[17]
Allende-Vigo M, Gonzalez-Rosario R, Gonzalez L, et al. Inpatient management of diabetes mellitus among non-critically ill patients at the university hospital of Puerto Rico: inpatient diabetes management. Endocr Pract 2014; 20(5): 452-60.
[18]
Cheekati V, Osburne R, Jameson K, et al. Perception of resident physicians about management of inpatient hyperglycemia in an urban hospital. J Hosp Med 2009; 4(1): E1-8.
[19]
Cobaugh D, Maynard G, Cooper L, et al. Enhancing insulin-use safety in hospitals: Practical recommendations from an ASHP Foundation expert consensus panel. Am J Health Syst Pharm 2013; 70(16): 1404-13.
[20]
Beliard R, Muzykovsky K, Vincent W 3rd, Shah B, Davanos E. Perceptions, barriers, and knowledge of inpatient glycemic control: A survey of health care workers. J Pharm Pract 2016; 29(4): 348-54.
[21]
John J, Lu J, Rascati K, et al. Analysis of glycemic control of a pharmacistled medication management program in patients with type 2 diabetes. J Manag Care Spec Pharm 2016; 22(1): 32-7.

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