Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
J Hosp Med. 2010 Oct;5(8):438-45. doi: 10.1002/jhm.780.
The optimal approach to managing hyperglycemia in noncritically ill hospital patients is unclear.
To investigate the effects of targeted quality improvement interventions on insulin prescribing and glycemic control.
A cohort study comparing an intervention group (IG) to a concurrent control group (CCG) and an historic control group (HCG).
University of Michigan Hospital.
Hyperglycemic, noncritically ill hospital patients treated with insulin.
Physician and nurse education and a standardized insulin order form based on the principles of physiologic insulin use.
Glycemic control and insulin prescribing patterns.
Patients in the IG were more likely to be treated with a combination of scheduled basal and nutritional insulin than in the other groups. In the final adjusted regression model, patients in the IG were more likely to be in the target glucose range (odds ratio [OR], 1.72; P = 0.01) and less likely to be severely hyperglycemic (OR, 0.65; P < 0.01) when compared to those in the CCG. Patients in the IG were also less likely to experience hypoglycemia than those in the CCG (P = 0.06) or the HCG (P = 0.01). Over 80% of all patient-days for all groups contained glucose readings outside of the target range.
Standardized interventions encouraging the physiologic use of subcutaneous insulin can lead to significant improvements in glycemic control and patient safety in hospitalized patients. However, the observed improvements are modest, and poor metabolic control remains common, despite these interventions. Additional research is needed to determine the best strategy for safely achieving metabolic control in these patients.
非危重症住院患者高血糖的最佳管理方法尚不清楚。
研究以目标为导向的质量改进干预措施对胰岛素处方和血糖控制的影响。
比较干预组（IG）、同期对照组（CCG）和历史对照组（HCG）的队列研究。
密歇根大学医院。
接受胰岛素治疗的高血糖非危重症住院患者。
医生和护士教育以及基于生理胰岛素使用原则的标准化胰岛素医嘱单。
血糖控制和胰岛素处方模式。
IG 患者更有可能接受预定基础胰岛素和营养胰岛素联合治疗，而其他组则不然。在最终调整的回归模型中，IG 患者的血糖目标范围内的可能性更高（比值比[OR]，1.72；P = 0.01），严重高血糖的可能性更低（OR，0.65；P < 0.01）与 CCG 相比。IG 患者发生低血糖的可能性也低于 CCG（P = 0.06）或 HCG（P = 0.01）。所有组超过 80%的患者日血糖读数超出目标范围。
鼓励使用皮下胰岛素的生理方法的标准化干预措施可显著改善住院患者的血糖控制和患者安全性。然而，尽管采取了这些干预措施，代谢控制仍不理想，且改善程度有限。需要进一步研究以确定在这些患者中实现代谢控制的最佳策略。
