TY - JOUR T1 - Implementation of subcutaneous insulin protocol for non-critically ill hospitalized patients in Andalusian tertiary care hospitals JO - Endocrinología y Nutrición (English Edition) T2 - AU - Martínez-Brocca,María Asunción AU - Morales,Cristóbal AU - Rodríguez-Ortega,Pilar AU - González-Aguilera,Beatriz AU - Montes,Cristina AU - Colomo,Natalia AU - Piédrola,Gonzalo AU - Méndez-Muros,Mariola AU - Serrano,Isabel AU - Ruiz de Adana,Maria Soledad AU - Moreno,Alberto AU - Fernández,Ignacio AU - Aguilar,Manuel AU - Acosta,Domingo AU - Palomares,Rafael SN - 21735093 M3 - 10.1016/j.endoen.2015.02.002 DO - 10.1016/j.endoen.2015.02.002 UR - https://www.elsevier.es/en-revista-endocrinologia-nutricion-english-edition--412-articulo-implementation-subcutaneous-insulin-protocol-for-S2173509315000197 AB - IntroductionIn 2009, the Andalusian Society of Endocrinology and Nutrition designed a protocol for subcutaneous insulin treatment in hospitalized non-critically ill patients (HIP). ObjectiveTo analyze implementation of HIP at tertiary care hospitals from the Andalusian Public Health System. MethodA descriptive, multicenter study conducted in 8 tertiary care hospitals on a random sample of non-critically ill patients with diabetes/hyperglycemia (n=306) hospitalized for ≥48h in 5 non-surgical (SM) and 2 surgical (SQ) departments. Type 1 and other specific types of diabetes, pregnancy and nutritional support were exclusion criteria. Results288 patients were included for analysis (62.5% males; 70.3±10.3 years; 71.5% SM, 28.5% SQ). A scheduled subcutaneous insulin regimen based on basal-bolus-correction protocol was started in 55.9% (95%CI: 50.5–61.2%) of patients, 63.1% SM vs 37.8% SQ (p<.05). Alternatives to insulin regimen based on basal-bolus-correction included sliding scale insulin (43.7%), diet (31.3%), oral antidiabetic drugs (17.2%), premixed insulin (1.6%), and others (6.2%). For patients previously on oral antidiabetic drugs, in-hospital insulin dose was 0.32±0.1IU/kg/day. In patients previously on insulin, in-hospital insulin dose was increased by 17% [−13–53], and in those on insulin plus oral antidiabetic drugs, in-hospital insulin dose was increased by 26.4% [−6–100]. Supplemental insulin doses used for <40IU/day and 40–80IU/day were 72.2% and 56.7% respectively. HbA1c was measured in 23.6% of patients (95CI%: 18.8–28.8); 27.7% SM vs 13.3% SQ (p<.05). ConclusionsStrategies are needed to improve implementation of the inpatient subcutaneous insulin protocol, particularly in surgical departments. Sliding scale insulin is still the most common alternative to insulin regimen based on basal-bolus-correction scheduled insulin. Metabolic control assessment during hospitalization should be encouraged. ER -