Physicians have knowledge about insulin use but blood sugar targets not achieved in inpatients

USA: Physicians, although well equipped with use of insulin for the management of inpatients with high blood sugar but are still not able to achieve appropriate blood sugar targets, reports a recent study.

The study, published in the AACE journal Endocrine Practice, has found that resident physicians feel more comfortable in managing inpatient hyperglycemia (high blood sugar) but had difficulty in identifying appropriate inpatient blood sugar target values.

This is the largest evaluation of resident physician perceptions and knowledge of inpatient glycemic control (IGC) currently published in the medical literature.

Uncontrolled inpatient hyperglycemia can lead to increased infection rates and mortality, longer hospitalization stays, increased rates of readmission and many other adverse outcomes. Some previous studies in both critically and noncritically ill hyperglycemic inpatients had demonstrated that improving IGC ca reduce rates of hospital complications, costs and infections. IGC is often poor in more than 90% of the diabetes patients who are admitted for reasons unrelated to the disease. They are often cared for by staff without specific diabetes expertise.

Many strategies have been adopted in a bid to improve IGC including standardized insulin order sets, mentoring, diabetes care team intervention, computerized systems, physician and nurse education, and resident physician education.

In this descriptive study, William B. Horton, University of Virginia School of Medicine, Charlottesville, VA, and colleagues evaluated perceptions and knowledge of inpatient glycemic control among resident physicians.

The study involved a survey of 246 internal medicine (90.6%) and medicine-paediatrics (9.4%) resident physicians (34.1% PGY1, 33.7% PGY2, 25.6% PGY3, 6.5% PGY4) at 4 US academic medical centres.

Also Read: Elevated Blood sugar in diabetes may damage DNA and lead to cancer

Key findings include:

• Most respondents (85.4%) reported feeling comfortable treating and managing inpatient hyperglycemia, and a majority (66.3%) agreed they had received an adequate education.


• Despite self-reported comfort with knowledge, only 51.2% of respondents could identify appropriate glycemic targets in critically ill patients.


• Only 45.5% correctly identified appropriate inpatient random glycemic target values in non-critically ill patients, and only 34.1% of respondents knew appropriate pre-prandial glycemic targets in non-critically ill patients


• A small majority (54.1%) were able to identify the correct fingerstick glucose (FSG) value that defines hypoglycemia.


• System issues were the most commonly cited barrier to successful inpatient glycemic control.

Also Read: OneDraw A1C Test gets FDA clearance for long term blood sugar monitoring

"Future interventions could utilize the IGCQ as a pre- and post-assessment tool and focus on early resident education along with improving system environments to aid in successful inpatient glycemic control," concluded the authors.

To read the complete study follow the link: https://doi.org/10.4158/EP-2019-0299