Elsevier

Endocrine Practice

Volume 13, Issue 2, January 2007, Pages 117-125
Endocrine Practice

Original Article
Management of Inpatient Hyperglycemia: Assessing Perceptions and Barriers to Care Among Resident Physicians

https://doi.org/10.4158/EP.13.2.117Get rights and content

ABSTRACT

Objective:

To develop insight into resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal management.

Methods:

As part of a planned educational program, a questionnaire was designed and administered to determine the opinions of residents about the importance o inpatient glucose control, their perceptions about what glucose ranges were desirable, and the problems they encountered when trying to manage hyperglycemia in hospitalized patients.

Results

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.

Conclusion

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. (Endocr Pract. 2007;13:117-125)

Section snippets

INTRODUCTION

Hyperglycemia in hospitalized patients is associated with worse outcomes (such as longer lengths of stay and higher mortality) in comparison with outcomes for patients without elevated blood glucose levels 1., 2.. Both randomized controlled trials and observational studies, however, have shown that outcomes can be improved with aggressive management of hyperglycemia 1., 2.. Consequently, glucose targets have been proposed for critically and non-critically ill patients in the hospital (2). In

Setting

Our academic teaching hospital is a 200-bed tertiarycare facility located in metropolitan Phoenix, Arizona. All adult general medical and surgical specialties are represented, including transplantation services (kidney, liver, pancreas, and, most recently, heart), a level 2 trauma center, and an inpatient rehabilitation unit. Various types of practitioners provide patient care in our hospital, including postgraduate trainees (residents), medical school faculty, physician assistants, and

Respondent Demographics

Responses were obtained from 52 of 70 residents (74% response). The mean age of the respondents was 31 years, 48% were men, 37% were in their first year of residency training, and 33% were 2005 graduates of medical schools. The residents represented the following departments: 44% internal medicine (N = 23), 25% general surgery (N = 13), 17% family medicine (N = 9), and 14% other (for example, transitional year, urology, or neurology; N = 7).

Perception About the Inpatient Burden of Diabetes

When the residents were asked to estimate the

DISCUSSION

Before hospitals can develop high-quality improvement and educational programs focused on inpatient hyperglycemia, they will need more insight into how their health care practitioners view the importance of inpatient glycemic control and what problems must be overcome in its successful treatment. Beliefs about diabetes have been explored in the past 10., 11., 12., but reported data specific to the inpatient setting are lacking. As part of a planned educational effort directed at enhancing

CONCLUSION

Despite the noted limitations, the results from this pilot study have already enabled us to focus our educational efforts to improve inpatient glycemic control. Most residents acknowledge the importance of good inpatient glucose control and have set target glucose ranges consistent with existing guidelines. Although these concepts should still be reinforced, our educational efforts must review therapeutic options, emphasize appropriate use of insulin in hospitalized patients, and focus on

DISCLOSURE

The authors have no conflicts of interest to disclose.

ACKNOWLEDGMENT

We thank Frederick D. Edwards, MD, Residency Program Director for Family Medicine; Richard J. Gray, MD, Residency Program Director for General Surgery; and Keith J. Cannon, MD, Residency Program Director for Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, for their help in administering the surveys. We also thank Laurie Wilshusen, MA, marketing consultant, Department of Public Affairs, Mayo Clinic Rochester, Rochester, Minnesota, for valuable input on the questionnaire. Editing,

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