Bridge over troubled waters: Safe and effective transitions of the inpatient with hyperglycemia

Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients

“…[Quality of evidence: very low] Several models have been proposed for transition from insulin infusion to SQ insulin therapy (156,(158)(159)(160)(161). The majority of these models include a threecomponent approach to insulin replacement: basal insulin, nutritional insulin, and correction insulin.…”

“…[Quality of evidence: very low] Specific patient groups have been shown to benefit from transition to a scheduled SQ insulin regimen, including type 1 diabetes patients, type 2 diabetes patients on insulin as outpatients, type 2 diabetes patients receiving insulin infusion at a rate of >0.5 unit/hr, or stress hyperglycemia patients receiving insulin infusion at a rate of >1 unit/hr (152)(153)(154)(155)(156).…”

Subcutaneous insulin order sets and protocols: Effective design and implementation strategies

“…Improved documentation can also improve the business case for glycemic control, along with other strategies outlined elsewhere in this supplement. 13 Transitions in care (including transitions out of the hospital and off of infusion insulin) are discussed in more detail 14,15 elsewhere in this supplement. The principles outlined in these references should be incorporated into your institutional protocol.…”

“…The HbA1c can be very valuable in arriving at the optimal outpatient regimen. 14 The capacities and preferences of the patient and the context of his or her outpatient care environment (including the preferences of the primary care provider) must be taken into consideration as an outpatient management program is planned.…”

Introduction: Overview of efforts and lessons learned

“…Subsequently, this comprehensive but somewhat sprawling implementation guide evolved into these more sophisticated and concise articles. [4][5][6][7][8][9][10] The topics include a review of the rationale for improving inpatient glycemic control, 4 an important call for standardizing the metrics of glycemic control, 9 subcutaneous insulin regimens and order sets, 5,6 insulin infusion protocols, 7 transitions of care, 8 and the business case for glycemic control. 10 It has been a long but rewarding and educational journey, drawing on the collective experience from dozens of institutions in all kinds of inpatient care settings.…”