Long-term improvements in insulin prescribing habits and glycaemic control in medical inpatients associated with the introduction of a standardized educational approach

Barriers to Insulin Progression Among Patients With Type 2 Diabetes

“…23 On a 5-point Likert scale, physicians indicated great willingness to prescribe the new basal-bolus therapy (median [interquartile range] = 5 ). Most (4 [4][5]) agreed that standardized basalbolus insulin therapy would provide better control than the former sliding scale protocol, but most also had concerns about a greater risk of hypoglycemia (4 [2.5-5]).…”

Perspectives on Learning and Clinical Practice Improvement for Diabetes in the Hospital: A Review of Educational Interventions for Providers

“…This was evident in the study design by Baldwin and colleagues (34), in which providers had an opportunity for practice within guided clinical rounds. This notion is also supported by Ena and colleagues’ study (40), in which educational material was readily available in working areas when care decisions were required. This is relevant in the care of patients with diabetes in the hospital, considering that sliding scale insulin as monotherapy is in most cases a retroactive treatment approach that attempts to correct hyperglycemia only after it has occurred instead of preventing it.…”

“…Notoriously complex glucose management scenarios, such as corticosteroid-associated hyperglycemia and pre-operative care, seem to benefit from the use of an assistive device to provide information to clinicians and guide their practice (39). The failure to sustain clinical goals achieved as time after education elapses (40) raises the concern for the reliability and accountability of processes needed to maintain quality of patient care. Further, knowledge appears to plateau among more advanced residents and among faculty (44).…”

The frequency and impact of hypoglycemia among hospitalized patients with diabetes: A population-based study

“…Conversely, the slight reduction in the rate of secondary hypoglycemia observed from 2008 could be partially explained by the less stringent glycemic targets in the in-patient setting recommended by more recent guidelines (Moghissi, Korytkowski, DiNardo, et al, 2009). In addition, the progressive change in Spanish hospitals from sliding-scale regimens to a basal-bolus insulin regimen (Ena et al, 2009;Gomez-Huelgas, Lopez-Carmona, Jansen-Chaparro, et al, 2014) may contribute to this reduction in the trend of secondary hypoglycemia considering that sliding-scale insulin regimens have been associated with high rates of hypoglycemia Queale, Seidler, & Brancati, 1997).…”