Hilda & J. Lester Gabrilove Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Diabet Med. 2013 Aug;30(8):994-8. doi: 10.1111/dme.12151. Epub 2013 Mar 21.
An online diabetes course for medical residents led to lower patient blood glucose, but also increased hypoglycaemia despite improved trainee confidence and knowledge. Based on these findings, we determined whether an optimized educational intervention delivered to hospitalists (corresponding to an Acute Physician or Specialist in Acute Hospital Medicine in the UK) improved inpatient glycaemia without concomitant hypoglycaemia.
All 22 hospitalists at an academic medical centre were asked to participate in an online curriculum on the management of inpatient dysglycaemia in autumn 2009 and a refresher course in spring 2010.
All hospitalists completed the initial intervention. Median event blood glucose decreased from 9.3 mmol/l (168 mg/dl) pre-intervention to 7.8 mmol/l (141 mg/dl) post-intervention and 8.5 mmol/l (153 mg/dl) post-refresher (P < 0.001 for both). Hospitalizations categorized as hyperglycaemia decreased from 83.3 to 55.6% (P = 0.014), with a trend towards euglycaemia (10-28.9%, P = 0.08) and no change in hypoglycaemia. Hyperglycaemic patient-days decreased from 72.0 to 57.3% (P = 0.004), with greater target glycaemia (27.3-39.4%, P = 0.016) and no change in hypoglycaemia.
An optimized online educational intervention delivered to hospitalists yielded significant improvements in inpatient glycaemia without increased hypoglycaemia.
一项针对住院医师的在线糖尿病课程可降低患者血糖，但也会增加低血糖，尽管受训者的信心和知识有所提高。基于这些发现，我们确定向医院医生（相当于英国的急症医师或急症医院医学专家）提供优化的教育干预措施是否可以改善住院患者的血糖，而不会同时增加低血糖。
要求学术医疗中心的所有 22 名医院医生在 2009 年秋季参加在线课程，学习住院患者血糖紊乱的管理，并在 2010 年春季参加复习课程。
所有医院医生都完成了初始干预。中位事件血糖从干预前的 9.3mmol/l（168mg/dl）降至干预后的 7.8mmol/l（141mg/dl）和复习后的 8.5mmol/l（153mg/dl）（均<0.001）。分类为高血糖的住院治疗从 83.3%降至 55.6%（P=0.014），而血糖正常（10-28.9%，P=0.08）和低血糖无变化的趋势。高血糖患者天数从 72.0%降至 57.3%（P=0.004），目标血糖更高（27.3-39.4%，P=0.016），低血糖无变化。
向医院医生提供优化的在线教育干预措施可显著改善住院患者的血糖，而不会增加低血糖。
