Evaluation of a Standardized Obstetrics Insulin Drip Protocol and Order Set.

Abstract

Objective: The prevalence of pregnancies affected by diabetes is increasing, with the Centers for Disease Control and Prevention reporting that 1-2% of pregnant women have type 1 or type 2 diabetes and up to 10% of pregnancies are affected by gestational diabetes as of 2018. Maternal glycemic management is directly related to fetal and neonatal outcomes, and aberrant maternal hyperglycemia has known negative outcomes. Although most of glycemic management centers on outpatient treatment, evidence exists to support the use of intravenous insulin drips during inpatient admissions. This study aimed to evaluate an intravenous insulin protocol specific to the obstetric (OB) population.

Research design and methods: This was a single-center retrospective pre-/post- cohort study of OB patients with diabetes admitted to an academic medical center. Groups were differentiated based on admission date and protocol implementation with a 6-month washout period. Included patients received an intravenous insulin drip around either antenatal corticosteroid administration or during labor and delivery. Those who were within 7 days of receiving a diabetic ketoacidosis diagnosis or who were admitted to an intensive care unit were excluded.

Results: Fifty-nine patients received 69 distinct insulin drip orders. Twelve drips were included in the group admitted before initiation of the insulin drip protocol (pre-group) and 57 in the group admitted after the protocol went into effect (post-group). Time spent within the goal glucose range while on an insulin drip in the pre-group was 1.63% compared with 39.30% in the post-group (P <0.001). Glucose levels <70 mg/dL was 0.00% in the pre-group compared with 3.23% in the post-group (P = 0.045). There were no differences in severe hypoglycemia (glucose <50 mg/dL), hyperglycemia (glucose >110 mg/dL), or neonatal outcomes.

Conclusion: Implementation of a nursing-driven, obstetrics-specific intravenous insulin drip protocol significantly improved maternal glycemic management within a goal glucose range of 70-110 mg/dL during antenatal corticosteroid administration and labor and delivery.