Inpatient self-management for diabetes effective

Issue: June 2016

ORLANDO, Fla. — Inpatients with diabetes may effectively manage their own diabetes and achieve diabetes care equally as effective as standard nursing care.

“Inpatient management of diabetes consumes significant staff resources,” Peter Thule, MD, professor of medicine in the department of medicine at Emory University, and colleagues wrote in an abstract that was presented at the American Association for Clinical Endocrinologists Annual Scientific and Clinical Congress. “In contrast to outpatient strategies, patients are typically excluded from glycemic management when hospitalized.”

Peter Thule

Thule and colleagues evaluated 36 patients from medical and surgical wards of the Atlanta VA Medical Center and randomly assigned them to a control group (n = 18) or self-care group (n = 18) to determine whether inpatients can effectively self-administer insulin and self-monitor blood glucose in the hospital and achieve care standards equal to standard nursing care.

Usual nursing care was administered to the control group whereas the self-care group self-administered all insulin doses and logged finger stick blood glucose and insulin dose time at bedside.

The primary outcomes included number of blood glucose measurements and insulin doses administered vs. ordered, percentage of correct insulin dosages, number of blood glucose greater than 200 or lower than 70, and average blood glucose.

Compliance with blood glucose checks was greater in the control group (95.1%) compared with the self-care group (90.4%; P = .0324); however, compliance with insulin administration was greater in the self-care group compared with the control group (89.6% vs. 80.8%; P = .0035). The control group was more likely to have the correct insulin dose compared with the self-care group (97.6% vs. 91.9%; P = .0018). The self-care group was less likely to have hypoglycemia compared with the control group (2.3% vs. 5%; P = .0448). There were no significant differences between the two groups for frequency of hyperglycemia or average blood glucose.

“Self-care patients had inferior compliance with [blood glucose] monitoring and lower rates of insulin given at correct dosages, but exhibited better compliance with insulin administration and less hypoglycemia compared to those under usual nursing care,” the researchers wrote. “There was no significant difference in average [blood glucose] or rates of hyperglycemia. While these data are promising, a study involving a larger number of patients is needed to further examine the utility of self-care in the hospital.”

Further, “this study provides evidence that some patients are willing and able to safely self-manage diabetes while in hospital,” Thule told Endocrine Today. “Future studies will be needed to confirm suspected cost savings and further identify appropriate patients.” – by Amber Cox

Reference:

Lee M, et al. Abstract 214. Presented at: AACE Annual Scientific and Clinical Congress; May 25-29, 2016; Orlando, Fla.

Disclosure: Thule reports no relevant financial disclosures.