SHM Converge Scientific Abstract ePoster Gallery-Don't Hold the Metformin! Enhancing the Inpatient Diabetes Order Set to Encourage Best Practices

Pdf Summary

A large 11-hospital safety net system tested an intervention to improve inpatient diabetes management by encouraging use of oral medications and evidence-based insulin regimens. The project was driven by two key ideas: metformin and sitagliptin are generally safe to continue in the hospital, and basal insulin or basal-bolus therapy is more effective than sliding-scale insulin alone.<br /><br />The intervention was multi-pronged and included staff education, local clinical consensus guidelines, and enhancements to the electronic medical record order set. The goal was to increase use of oral diabetes medications and basal insulin while improving overall glycemic control.<br /><br />After implementation, orders for metformin and sitagliptin increased by 21.7% per 1,000 patient-days compared with the pre-intervention period. Basal insulin use remained essentially unchanged. Importantly, the system also saw favorable safety outcomes: both hyperglycemia and hypoglycemia rates decreased, suggesting that increasing oral medication use did not worsen inpatient glucose control.<br /><br />Overall, the study shows that changing inpatient diabetes practice is feasible in a large public hospital system. Updating order sets and providing clinical education can shift prescribing toward best practices, potentially improving both inpatient glucose management and transitions to outpatient diabetes care.

Asset Subtitle

Samantha F. Sanders

Meta Tag

Author List Amanda Klinger, Brianna Knoll, Daniel Alaiev, Fiona Fitzgerald, Hyung Cho, Ian Fagan, Michael Shen, Samantha F. Sanders

Category Innovations

Concept Metformin

Concept Sitagliptin

Concept Oral Diabetes Medications

Concept Basal Insulin

Concept Basal-Bolus Regimen

Distinguished Non-Finalist

Presenter Organization NYU Grossman School of Medicine

Presenting Author Samantha F. Sanders

Track Quality Improvement

Keywords

inpatient diabetes management

metformin

sitagliptin

basal insulin

basal-bolus therapy

sliding-scale insulin

hospital order sets

clinical education

glycemic control

safety net hospital system

Metformin

Sitagliptin

Oral Diabetes Medications

Basal Insulin

Basal-Bolus Regimen