SHM Converge Scientific Abstract ePoster Gallery-A Multimodal Intervention to Improve Glycemic Control in Hospitalized Patients

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This study evaluated whether updating inpatient insulin order sets to align with American Diabetes Association guidelines would improve glucose control for non-critically ill hospitalized patients with diabetes at a tertiary academic medical center.<br /><br />Using a quasi-experimental design, researchers compared 360 days before and 360 days after implementation of a new multimodal order set, with a 2-month washout period. The intervention included revised insulin dosing guidance, embedded education for providers and pharmacists, shared usage comparisons, and accessory orders such as HbA1c testing and diabetes educator consults.<br /><br />The study included 1,298 pre-intervention and 1,264 post-intervention encounters. Provider uptake of the new order set was high at 83.4%. After adjustment for baseline differences, total daily insulin dose decreased significantly, driven by lower short-acting insulin use. However, glycemic control worsened: mean blood glucose increased, the proportion of blood glucose values in the target range decreased, and the risk of severe hyperglycemia (blood glucose ≥300 mg/dL) increased. There was no significant change in glycemic variability or hypoglycemia rates. Length of stay increased modestly, but there were no significant changes in readmission or in-hospital mortality.<br /><br />The authors concluded that while the new order set changed prescribing behavior, it did not improve glycemic outcomes and was associated with more hyperglycemia without reducing hypoglycemia. They suggest that inpatient glycemic safety likely depends on broader system factors beyond insulin dosing algorithms alone. Ongoing quality-improvement efforts are focused on identifying and addressing root causes of inpatient hyperglycemia-related errors and adverse events.

Asset Subtitle

David Holzer

Meta Tag

Author List Alexander Brauer, Danielle Babbel, David Holzer, Hannah Wilkerson, Kasey Stoutin, Katie Kaput, Ryan D. Murphy, Stacy Johnson, Tamara Cisowska

Category Research

Concept Inpatient Insulin Order Set

Concept Glycemic Control

Concept ADA Grade A Recommendation

Concept Quasi-Experimental Study

Concept Pre-Post Study

Distinguished Non-Finalist

Presenter Organization University of Utah School of Medicine

Presenting Author David Holzer

Track Quality Improvement

Keywords

inpatient insulin order sets

diabetes management

American Diabetes Association guidelines

glycemic control

hospitalized patients

quasi-experimental study

hyperglycemia

insulin dosing

quality improvement

tertiary academic medical center

Inpatient Insulin Order Set

Glycemic Control

ADA Grade A Recommendation

Quasi-Experimental Study

Pre-Post Study