Implementation of a Standardized Admission Hyperglycemia Insulin Order Set in a Veterans Hospital

Abstract

Inpatient hyperglycemia is a common problem during hospitalization affecting numerous patients across institutions worldwide. Diabetes mellitus was associated with over 7.7 million hospitalizations in the United States in 2008, contributing to the incidence of inpatient hyperglycemia and increased hospital costs [1,2]. The management of inpatient hyperglycemia is affected by a multitude of factors, including acute illness, concurrent medications, inconsistent caloric intake, and insulin administration [3]. Stress hyperglycemia and various medications such as corticosteroids, calcineurin inhibitors, and atypical antipsychotics can increase glucose levels in patients, with or without diabetes mellitus [4]. Additionally, outpatient oral antihyperglycemic agents are typically discontinued during hospitalization to prevent complications with inpatient management, furthering the risk of hyperglycemia. Conversely, inconsistent dietary intake due to illness-associated loss of appetite, “nothing by mouth” (NPO) dietary precautions, and improper insulin use may increase the risk of hypoglycemia [4]. Hyperglycemia in hospitalized patients with or without diabetes mellitus has significant impact on patient care as it has been associated with worsened outcomes, including increased rates of infection, longer lengths of stay, and increased mortality [57]. Therefore, effective inpatient hyperglycemia management is essential to optimize patient outcomes.