Abstract

Study: Hypoglycemia (hG) affects up to 26% of inpatients with diabetes mellitus (DM) and is responsible for an increase in cardiovascular morbidity and mortality.
Objective: The goal of this pilot project (PP) was to decrease inpatient hG.
Methods: A hospital wide PP was implemented by giving the basal insulin in the morning, bolus insulin postprandial, using lower doses of corrective insulin and withholding of prandial insulin if food intake was less than 50%. The frequency rate of hG, as reported in the Patient Safety Network, was compared between patients on standard insulin regimens (control group) and patients enrolled in the PP (intervention group).
Results: A total of 46 type 2 DM patients, were reported to experience hG during the 8 month study period. Among these patients, 36/46 (78%) of hypoglycemic episodes occurred in the control group ( incidence rate - 0.16 episodes per patient per year). In contrast, only 10/46 (22%) of patients experienced hG in the intervention group (incidence rate - 0.04 episodes per patient per year). The risk of hG was 3.66 times higher among the patients in the control group (standard insulin users) vs intervention group (modified insulin regimens), p<0.05. The utilization of D50%, as rescue treatment for severe hG, decreased by 70% in the intervention group.
Conclusion: The modification of standard timing of insulin administration, significantly decreased the frequency rate of hypoglycemia in our study population. Since prevention of hypoglycemia is a safety issue in the management of diabetes, additional studies are needed to assess if the above changes and intervention consistently reduce the risks of hypoglycemia in a larger inpatient and outpatient diabetic populations.