Understanding and improving management of inpatient diabetes mellitus: the Mayo Clinic Arizona experience

Abstract

We present an overview of strategies our institution has taken to understand the state of its inpatient diabetes management. We first describe how we utilized information systems to assess inpatient glycemic control and insulin management in noncritically ill patients and discuss our findings regarding mean bedside glucose levels, the prevalence and frequency hypoglycemic and hyperglycemic events, the patterns of insulin therapy, and evidence of inpatient clinical inertia. We also review the development of a survey to determine practitioner attitudes and beliefs about inpatient diabetes. Results of this survey study found that, in general, practitioners believed in the importance of controlling hyperglycemia but were not comfortable with many aspects of inpatient diabetes care, particularly with the use of insulin. Finally, we suggest steps to follow in developing a quality-improvement program for hospitals.

Keywords: diabetes mellitus hospitalizations; hyperglycemia; hypoglycemia; insulin.

Figure 1.

Distribution of average bedside glucose values (mg/dl) for (A) F24BedGluc_avg, for (B) BedGluc_avg, and for (C) L24BedGluc_avg. Reprinted with permission from Cook et al.

Figure 2.

Frequency of (A) hypoglycemic measurements and (B) hyperglycemic measurements. Reprinted with permission from Cook et al.

Figure 3.

Distribution of therapies by BedGluc_avg tertiles: tertile 1 (129 mg/dl), tertile 2 (165 mg/dl), and tertile 3 (219 mg/dl). Reprinted with permission from Cook et al.

Figure 4.

Changes in insulin regimen (left, N = 2084) and in the amount of insulin administered (right, N = 1680) by tertiles of BedGluc_avg. Reprinted with permission from Cook et al.