Improving Glycemic Control Safely in Non-Critical Care Patients: A Collaborative Systems Approach in Nine Hospitals

Impact of an inpatient multidisciplinary glucose control management program

“…These protocols need to be constantly reevaluated and updated based on newly available evidence in the literature and on local demands of patient care. Other centers have described similar improvements in clinical outcomes with the adoption of insulin protocols for glucose management in critical and noncritical patients (17,18,23,29,30,(31)(32)(33).…”

“…Our educational programs focused on the major challenges to optimal glucose management. Similar to other centers, the main obstacles we encountered included unanticipated nutritional changes, poor coordination of the POCT with the administration of insulin around mealtime, unanticipated changes in clinical status or medications, use of medications associated with increased insulin resistance (such as glucocorticoids, often in variable and changing doses), failure by clinicians of making adjustments in glycemic therapy based on daily blood glucose patterns, prolonged use of sliding scale insulin as monotherapy, multiple system/organizational barriers such as lack of communication and/or deficient knowledge of diabetes management among providers and caregivers (7,29,30,32,33). Notably, we demonstrated that a collaborative work of the nurses, dietitians, and physicians reduced the inadequacy of the prescription with the type of diet and improved the coordination of POCT and administration of insulin around mealtime.…”

“…Therefore, our results of reduced hyperglycemia without increased hypoglycemic events demonstrate that our institutional protocols were safe. Indeed, it has been demonstrated that the implementation of standardized insulin order sets with less strict glycemic targets and frequent glucose monitorization are associated with better glycemic control and produce expected benefits in terms of patient safety across different hospitals (18,23,25,29,30,32,33).…”

“…In this scenario, the American College of Endocrinology, the American Diabetes Association, and the Brazilian Diabetes Society have released calls to action outlining strategies for a successful implementation of inpatient glucose control management programs (2,5,7). Systembased key issues outlined included the need for the development and evaluation of: 1) clinical protocols to guide management, clinical decisions, and prescriptions; 2) multidisciplinary glucose control management teams; and 3) provider-delivered educational programs to improve knowledge and address barriers to achieving glycemic control (2,5,7,29,30).…”

Pharmacists' role in glycemic management in the inpatient setting: An opinion of the endocrine and metabolism practice and research network of the American College of Clinical Pharmacy

“…Pharmacists are valuable members of the interdisciplinary glycemic management committee at many hospitals. These oversight committees develop policies, procedures, and protocols for safe and effective management and prevention of inpatient hyper‐ and hypo‐glycemia . The Joint Commission (TJC) requires inclusion of a pharmacist on such teams if the hospital desires Inpatient Diabetes Certification .…”