Department of Pharmacy Practice, St. Louis College of Pharmacy / Mercy Hospital St. Louis Saint Louis, Missouri, USA.
J Pharm Pharm Sci. 2019;22(1):85-92. doi: 10.18433/jpps30180.
Inpatient hyperglycemia is associated with poor outcomes. Existing research assessing inpatient hyperglycemia protocols has shown improvements in average blood glucose levels with inconsistent results regarding rates of hypoglycemia and hyperglycemia. The objective of this study was to evaluate the impact of an inpatient hyperglycemia protocol on glycemic control.
This retrospective cohort study at a large, community teaching hospital included adult patients in non-critical care units requiring insulin administration for glycemic control. The intervention examined was utilization of an inpatient hyperglycemia protocol, comprised of a computerized physician order entry order set and provider education at the time of implementation. Two cohorts, a pre-protocol implementation group and a post-protocol implementation group, were compared. The primary outcome was the incidence of blood glucose values within 70-180 mg/dL over a 72-hour period between groups. Key secondary outcomes included the incidence of hypoglycemia (less than 70 mg/dL), severe hyperglycemia (above 300 mg/dL), total insulin use, and hospital length of stay.
The primary outcome was significantly improved following protocol implementation (54.2% vs. 58.4%, p = 0.001). Compared to the pre-protocol group, the post-protocol group had lower incidence of hypoglycemia (3.1% vs. 1.2%, p < 0.001), severe hyperglycemia (9.9% vs. 6.7%, p < 0.001), less total insulin use (1.1 units/kg vs. 0.6 units/kg, p < 0.001), and shorter length of stay (5.1 days vs. 3.7 days, p < 0.001).
The implementation of an inpatient hyperglycemia protocol was associated with improved glycemic control, decreased incidence of both hypoglycemia and severe hyperglycemia, and less total insulin use.
住院患者高血糖与不良预后相关。现有评估住院患者高血糖治疗方案的研究表明，平均血糖水平有所改善，但低血糖和高血糖的发生率结果不一致。本研究旨在评估住院患者高血糖治疗方案对血糖控制的影响。
这是一项在一家大型社区教学医院进行的回顾性队列研究，纳入了需要胰岛素治疗以控制血糖的非重症监护病房的成年患者。研究的干预措施是使用住院患者高血糖治疗方案，包括计算机医生医嘱输入医嘱集和实施时的医务人员教育。将患者分为治疗方案实施前组和治疗方案实施后组进行比较。主要结局是两组患者在 72 小时内血糖值在 70-180mg/dL 之间的发生率。关键次要结局包括低血糖（<70mg/dL）、严重高血糖（>300mg/dL）、总胰岛素使用量和住院时间。
治疗方案实施后主要结局显著改善（54.2%比 58.4%，p=0.001）。与治疗方案实施前组相比，治疗方案实施后组低血糖发生率较低（3.1%比 1.2%，p<0.001），严重高血糖发生率较低（9.9%比 6.7%，p<0.001），总胰岛素使用量较少（1.1 单位/kg 比 0.6 单位/kg，p<0.001），住院时间较短（5.1 天比 3.7 天，p<0.001）。
实施住院患者高血糖治疗方案可改善血糖控制，降低低血糖和严重高血糖的发生率，并减少总胰岛素使用量。
