Hyperglycaemia is a significant issue in people with diabetes (DM) especially when unwell requiring hospitalisation. Poor in-patient glycaemic control is associated with increased morbidity and mortalitya. Knowledge by non-specialist teams regarding DM is frequently poor hence management is often facilitated via consultation with endocrine teams (ET). We previously reported that for people with T2DM and admitted to hospital, use of a standardised insulin protocol involving basal-bolus-booster doses (3BL) provided superior glycaemic outcomes compared to non ET managementb. However it is unknown whether an insulin protocol (3BL) is superior to regular ET management of in-patient hyperglycaemia.
Blood glucose levels (BGL) and actions taken to correct dysglycaemia 5 days prior to and post ET consultations for inpatient hyperglycaemia were collected for 12 months preceding and following the implementation of the 3BL protocol.
Data from 118 pre-3BL and 96 post-3BL ET consultations was analysed. The pre and post 3BL five day BGLs (mean ± SD) were not significantly different [pre 11.9 ± 8.1 mmol/L v post 10.9 ± 2.8 mmol/L, p=0.2], nor were the frequency of BGLs>14mmol/L (24% v 23%) nor the frequency of BGLs <4mmol/L (4% v. 3%). Of the actions taken by the ET pre protocol, 30% involved regular insulin, which was titrated in 18% of cases; 15% used stat or supplemental insulin and 20% made changes to oral hypoglycaemic agents. From post-3BL cases, 25% involved insulin titration and <10% cases either used stat insulin or adjusted oral agents.
Compared to specialist management of in-patient hyperglycaemia, a standardised insulin protocol was as effective while involving fewer actions. This suggests that a well-designed and easy to administer insulin protocol for in-patient hyperglycaemia could be considered as a suitable tool for use by non endocrine teams, hereby providing more timely management of this important issue.