Inpatient Diabetes Management: Examining Morning Practice in an Acute Care Setting.
From: Department of Nursing Services, College of Nursing Graduate Programs, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 52, Brooklyn, NY 11203, USA. linda.cohen@downstate.edu
The Diabetes educator
- Publish Date:
- ISSN: 0145-7217
- Volume: 33
- Issue: 3
- Pages: 483-92
- Medium: Print
- Language: English
- Citation (JAMA): Cohen Linda S, Sedhom Laila, Salifu Moro, et al. Inpatient Diabetes Management: Examining Morning Practice in an Acute Care Setting.. ;33:483-92
Abstract
PURPOSE: Morning diabetes management in an inpatient acute care facility was examined. METHODS: A descriptive, nonexperimental research design was used to study the effect of the following variables on patients’ prelunch blood glucose: duration of time between (1) blood glucose monitoring and insulin administration, (2) insulin administration and breakfast, and (3) blood glucose monitoring and breakfast. A nonprobability convenience sample was used to examine 40 adults with diabetes who were hospitalized in an urban, academic medical center. RESULTS: The chi2 test and measurements of central tendency were used for statistical analysis. The mean interval of time between (1) blood glucose monitoring and insulin administration was 93 minutes+/-52.82, (2) blood glucose monitoring and breakfast was 121+/-47 minutes, and (3) insulin administration and breakfast was 73+/-37.06 minutes. Insulin was administered in 28% of patients<45 minutes before breakfast, whereas in 39% and 33%, it was administered between 46 and 90 minutes and >90 minutes prior to breakfast, respectively. There was a statistically significant difference (P=.033) between mean prelunch glucose levels for subjects who received insulin>45 minutes before breakfast and mean glucose levels for those who received insulin<45 minutes before breakfast. Eighty percent of patients whose breakfast was >45 minutes following insulin had prelunch glucose values of >180 mg/dL (10 mmol/L) versus 20%<180 mg/dL (10 mmol/L). Of those whose breakfast was <45 minutes before insulin, 43% had blood glucose levels>180 mg/dL, and 57% had blood glucose<180 mg/dL (P=.026). A logistical regression model revealed that patients had a 5.3 times higher risk of having a prelunch blood glucose level>180 mg/dL when their breakfast time was >45 minutes after receiving insulin as compared to those whose insulin was given<45 minutes before breakfast (relative risk, 5.3; 95% confidence interval, 1.2-25; P=.031). CONCLUSION: Current practice suggests patients are at a higher risk of prelunch hyperglycemia, and multiple opportunities exist to improve care for the inpatient with diabetes.
Mesh Headings (Keywords): Blood Glucose, Diabetes Mellitus, Drug Administration Schedule, Feeding Behavior, Humans, Hyperglycemia, Hypoglycemic Agents, Inpatients, Insulin, Periodicity
Check for Full Text / PubMed Unique Identifier (PMID): 17570879
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