Abstract
S. K c: None. A. Sharma: None. N.K. Rai: None. N. Aslam: None. S. Lincoln: None. K. Singla: None. P. Shah: None. A. Rana: None. P. Gandikota: None.
Introduction: Adult patients with diabetes or newly recognized hyperglycemia account for over 30% of non-critically ill hospitalized patients. Both diabetes and hyperglycemia in the hospital are associated with prolonged hospital stay, increased incidence of complications, and disability after hospital discharge. Protocols that target recommended blood glucose levels of 100 to 180 mg/dL in noncritically ill patients with diabetes have the potential to ameliorate these observed adverse outcomes. This research study is targeted to determine the implementation of appropriate guideline-based protocols in a tertiary care center. And subsequent identification and discussion of setbacks. Methods: A descriptive cross-sectional study was conducted on 300 and 105 bedded tertiary care centers over a period of 4 months. Total 250 inpatient admissions with insulin dependent diabetes mellitus were included in the study from April 1 to July 31 2023.ICD 10 diagnosis code for Diabetes Mellitus was used. Goal was to determine initiation of sliding scale insulin along with basal bolus regimen in non-critically ill inpatient admissions. The inclusion criteria were patients with insulin dependent diabetes mellitus who were non-critically ill, non-ICU admissions. We excluded patients with diabetes ketoacidosis, pregnancy and septic shock, concerning labile blood glucose in these groups. Also, after the results were obtained, a survey was conducted among admitting physicians to identify potential setbacks hindering adherence to inpatient glycemic control management guidelines. Results: Out of 250 admissions with Diabetes Mellitus, 77.2% (193 patients) were started on insulin while in hospital. 68% of Insulin Dependent Diabetic patients who were on sliding scale insulin did not have their basal bolus insulin started at admission. Per the survey, the majority of admitting physicians were concerned about patients being NPO and the risk of hypoglycemia which was considered a major setback against use of basal bolus insulin at admission. Conclusion: There are potential setbacks that affect correct implementation of guidelines for inpatient glycemic control. Major concerns are hypoglycemia and the patient's dietary differences inside the hospital. Using hypoglycemia prediction tools, EMR alerts, physician educational courses for glycemic control inpatients could be incorporated early in training to attain adherence to ADA glycemic control guidelines.
Monday, June 3, 2024