Abstract

Inpatient diabetes mellitus: Institutional progress in management of an emerging hospital epidemic

Author(s): Bithika M. Thompson, Mohamed Temkit, Janna C. Castro, Toni R. Yubeta, RN Heidi A. Apsey & Curtiss B. Cook*

Objective: Assess changes in glycemic control and basal-bolus insulin use over 4 years in an academic teaching hospital. Methods: Point-of-care glucose and insulin administration data were obtained from electronic health records for patients with diabetes mellitus (DM) discharged from 2011 through 2014. Changes in patient-stay mean glucose, frequency of hyperglycemic measurements, and basal-bolus insulin therapy were evaluated. Results: There were 5,386 discharges with a DM diagnosis. No demographic differences were detected across the 4 years. The frequency of hyperglycemia and patient-stay mean glucose both declined significantly (P ≤ .02). Among patients in the highest tertile of hyperglycemia frequency, basal-bolus insulin therapy increased (P<.01) only among surgical patients. Increasing age, HbA1c, frequency of hyperglycemia, steroid use, and basal-bolus insulin therapy positively correlated with patient-stay mean glucose, whereas year of discharge was associated with lower values. Age, case-mix index, HbA1c, female sex, hyperglycemia frequency, and year of discharge all increased the odds of basal-bolus insulin therapy. Conclusions: This analysis provided insight into one institution’s progress in hospital DM care over time. Considerable study is still needed in the area to better understand how best to organize and deliver care to assure the best results for the patient and the health care system.