Introduction: A substantial proportion of inpatients experience hyperglycemia during hospitalization. Use of basal insulin has been recommended by ADA guidelines since 2007, however the uptake of this recommendation has been slow. Here, we characterize the adoption of basal insulin in inpatients at one adult academic hospital.
Methods: De-identified data from the hospital’s electronic health record repository was used to identify a cohort of patients who received subcutaneous insulin during their hospitalization between 03/26/2008 and 12/30/2018. To capture patients for whom a generalist could be expected to manage their hyperglycemia, we excluded patients receiving insulin via pump, U-500 insulin, single doses >100U, or insulins ordered < 10 times, as well as those with a creatinine > 2mg/dL at any time during admission.
Results: In the cohort of 61,947 inpatient encounters in which insulin was given, no basal insulin was ordered in 61%, decreasing from a 78% in 2008 to 53% in 2018. The annual number of encounters in which insulin was given increased >20% over the decade. The proportions of blood glucoses (BGs) > 200 mg/dL (28% vs. 14%) or <70 mg/dL (1.2% vs. 0.6%) were higher for patients ordered for basal insulin. Although hypoglycemia decreased over time (1.2% to 0.9% of BGs), hyperglycemia increased (16% to 26% of BGs).
Conclusions: Despite improvements since basal insulin became a guidelines recommendation, the rate of inpatient basal insulin orders remained < 50% as of 2018 at one academic center. The number of patients receiving insulin and the proportion of hyperglycemia has increased, whereas the incidence of hypoglycemia in this population decreased over time.
I. Jankovic: None. J. Chen: None.
Diabetes, Endocrinology, and Metabolism Training Grant (5T32DK007217-44)