Cook Curtiss B, McNaughton Dean A, Braddy Cathleen M, Jameson Kimberly A, Roust Lori R, Smith Steven A, Roberts Daniel L, Thomas Stephen L, Hull Bryan P
Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, Arizona 85259, USA.
Endocr Pract. 2007 Mar-Apr;13(2):117-24. doi: 10.4158/EP.13.2.117.
To develop insight into resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal management.
As part of a planned educational program, a questionnaire was designed and administered to determine the opinions of residents about the importance of inpatient glucose control, their perceptions about what glucose ranges were desirable, and the problems they encountered when trying to manage hyperglycemia in hospitalized patients.
Of 70 resident physicians from various services, 52 completed the survey (mean age, 31 years; 48% men; 37% in first year of residency training). Most respondents indicated that glucose control was "very important" in critically ill and perioperative patients but only "somewhat important" in non-critically ill patients. Most residents indicated that they would target a therapeutic glucose range within the recommended levels in published guidelines. Most residents also said they felt "somewhat comfortable" managing hyperglycemia and hypoglycemia and using subcutaneous insulin therapy, whereas most residents (48%) were "not at all comfortable" with use of intravenous administration of insulin. In general, respondents were not very familiar with existing institutional policies and preprinted order sets relating to glucose management. The most commonly reported barrier to management of inpatient hyperglycemia was lack of knowledge about appropriate insulin regimens and how to use them. Anxiety about hypoglycemia was only the third most frequent concern.
Most residents acknowledged the importance of good glucose control in hospitalized patients and chose target glucose ranges consistent with existing guidelines. Lack of knowledge about insulin treatment options was the most commonly cited barrier to ideal management. Educational programs should emphasize inpatient treatment strategies for glycemic control.
深入了解住院医师对住院患者高血糖的态度，并确定最佳管理的认知障碍。
作为一项计划中的教育项目的一部分，设计并发放了一份问卷，以确定住院医师对住院患者血糖控制重要性的看法、他们对理想血糖范围的认知，以及他们在试图管理住院患者高血糖时遇到的问题。
来自各个科室的70名住院医师中，52人完成了调查（平均年龄31岁；48%为男性；37%处于住院医师培训的第一年）。大多数受访者表示，血糖控制在危重症和围手术期患者中“非常重要”，但在非危重症患者中仅“有些重要”。大多数住院医师表示，他们会将治疗性血糖范围设定在已发表指南推荐的水平内。大多数住院医师还表示，他们在管理高血糖和低血糖以及使用皮下胰岛素治疗时感觉“有些得心应手”，而大多数住院医师（48%）对使用胰岛素静脉给药“一点也不自在”。总体而言，受访者对现有的与血糖管理相关的机构政策和预印医嘱集不太熟悉。住院患者高血糖管理最常报告的障碍是缺乏关于适当胰岛素治疗方案及其使用方法的知识。对低血糖的担忧仅排在第三。
大多数住院医师认识到住院患者良好血糖控制的重要性，并选择了与现有指南一致的目标血糖范围。对胰岛素治疗方案缺乏了解是理想管理中最常被提及的障碍。教育项目应强调住院患者血糖控制的治疗策略。
