American Diabetes Association (ADA) goals for hospitalized patients include: premeal blood glucose (BG) < 140 mg/dL, random BG < 180 mg/dL, and avoid hypoglycemia (BG < 70 mg/mL). To achieve these goals, the ADA recommends use of basal‐mealtime‐supplemental (BMS) insulin regimens, avoidance of sliding‐scale insulin monotherapy (SSIM), and adjustment of insulin based on BG. We evaluated a collaborative model involving hospital‐based pharmacist and hospitalist physicians for its effectiveness in increasing the implementation of ADA‐recommended regimens and on attainment of ADA glycemia targets in hospitalized patients.
This was a prospective, randomized, open‐label, parallel‐group trial in diabetic inpatients prescribed insulin. Hospitalist physician–led medical teams were randomized to study intervention (INV) or usual care (UC). In the INV group, to meet the ADA glycemia targets, hospital pharmacists evaluated BG control daily along with the nutritional intake of hospitalized patients. They made recommendations, as needed, for adjustment of the insulin regimen to the medical team using a weight‐based insulin dosing algorithm and ADA guidelines. Physicians in the UC group prescribed insulin according to their usual practice. Results were also compared with a historical cohort (HC).
One hundred and eighty‐eight UC and 181 INV subjects were enrolled over 29 weeks. Ninety‐six patients were studied in the HC. Mean daily blood glucose was 194 mg/dL in the HC, 176 mg/dL in the UC group, and 179 mg/dL in the INV group (P < 0.001 HC–INV). More insulin adjustments were performed in the INV group: 423 in the INV group, 184 in the UC group, and 94 in the HC group (P < 0.001 UC–INV). Hypoglycemic event days—10.8% in the HC group, 10% in the UC group, and 8.7% in the INV group—occurred less often in the INV group (P = NS). The INV group used basal insulin 60.3% of days versus 52% in the UC group (P < 0.001). BMS regimens were utilized 23.3% of the days in the INV group versus 18.5% in the UC group (P = 0.004). Use of SSIM was 46.2% in the UC group and 39.1% of days in the INV group (P < 0.001).
Hospitalist–‐pharmacist collaboration increased the use of basal insulin and BMS regimens and decreased the use of SSIM without increased risk of hypoglycemia. A nonscientific survey of the hospitalists showed that they valued the input of the hospital pharmacists in managing the insulin regimen of their patients.
S. Suri ‐ none; J. Ketz ‐ none; J. Yeh ‐ none
To cite this abstract:Suri S, Ketz J, Yeh J. Collaboration of Pharmacists and Hospitalists to Increase Use of Ada‐Recommended Insulin Regimens in Internal Medicine Patients: Implementation of a Pilot Program. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 121. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/collaboration-of-pharmacists-and-hospitalists-to-increase-use-of-adarecommended-insulin-regimens-in-internal-medicine-patients-implementation-of-a-pilot-program/. Accessed April 25, 2019.