Background The Andalusian Health Service insulinisation protocol for the non-critical patient is applied through a subcutaneous ‘Basal-Bolus-Correction’ technique. Our previous pilot study of glycaemic control in diabetic patients admitted to the hospital, revealed how 41%, with only insulin correction regimen without basal insulin and/or bolus (ICRw), presented at some time during their admission fasting glycaemia >140 mg/dl, and of these 10%>180 mg/dl. It is important to maintain at all times optimal glycaemic control.
Purpose To measure the impact of a multidisciplinary intervention to rationalise the use of ICRw in diabetic patients admitted to the hospital, analysing the-number-of-changes-of-regimen due to hyperglycaemia per 100 prescriptions of ICRw during and after the intervention.
Material and methods Intervention period
Daily selection during 1 month of diabetic patients with 3 days of ICRw and glycaemia >150 mg/dl, of the total of patients with ICRw prescription, using the electronic prescription program and electronic clinical history.
Daily intervention of the PROI group (group–for–the–optimisation–of–insulin–therapy) –endocrinology–pharmacy – in all selected patients, through a note with recommendations, in the electronic prescription program.
After 2 months , analysis post-intervention following the same procedure.
Results We analysed 337 patients with ICRw prescription in the intervention period and 182 in the post-intervention:
Percentage of diabetics patients with ICRw in the intervention period: 29% (97/337) and in the post–intervention: 22% (44/182).
Percentage of regimen–changes in patients with glycaemia >150 mg/dl and ICRw: 35% in the intervention period – 23 recommendations for change of insulin therapy and 11 follow–ups and posterior change – accepted 87%; and 9% in the post–intervention, all accepted.
Odds ratio: 0.1872 (CI 0.04486 to 0.583), Fisher’s Exact Test-, P:0.001. (OPEN-EPI 3.0.)
In the intervention period most prescriptions were in patients with home-based insulin therapy or with more than one oral antidiabetic: only 14% were patients with a single oral antidiabetic at home. In the post-intervention period, all were prescriptions in patients with a single oral anti-diabetic at home.
Conclusion After the intervention of the PROI group, ICRw prescription in the hospital was applied only to patients with single low doses of oral antidiabetics at home. The glycaemia in such cases is usually maintained below 150 mg/dl. The intervention of the multidisciplinary group PROI is considered effective.
No conflict of interest
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