Introduction: Insulin charts are the main tool for multidisciplinary documentation of diabetes therapy in the hospital setting. Due to a high heterogeneity of 20 different insulin charts at a tertiary center, a new standardized paper-based insulin chart was developed and implemented at the Departments of Internal Medicine.

Methods: A before-after comparison was performed to evaluate structure, documentation, and treatment quality of a new insulin chart compared to old insulin charts. Structure quality of blank insulin charts was assessed by using questionnaires regarding subjective perception of health care professionals (n=237). To assess documentation and treatment quality a retrospective evaluation of 108 old and 100 new filled-in insulin charts of inpatients receiving insulin therapy by using predefined quality parameters was conducted.

Results: Patient characteristics from old and new insulin charts were comparable regarding sex (old: 47% vs. new: 42% female), age (71±11 vs. 71±12 years), diabetes type (75% vs. 87% type 2) and HbA1c (62±14 vs. 67±21 mmol/mol). The primary endpoint, the percentage of insulin charts with insulin administration errors, was with 5% significantly better on new insulin charts compared to 77% on old insulin charts (p<0.001). Insulin prescription errors occurred more often on old insulin charts (100% vs. 42%), whereas insulin management errors were rare in both groups (10% vs. 8%). Correct patient identification was rather given on new insulin charts (78% vs. 90%). Both groups had an average of 4±2 good diabetes days. Structure of the new insulin chart was assessed to be more clearly arranged, to give better transparency and to have more space for documentation.

Conclusion: Improvements in structure, documentation, and treatment quality were achieved through implementation of the new insulin chart. However, as some errors still occur, further potential to enhance diabetes inpatient care should be considered.


J. Kopanz: None. K.M. Lichtenegger: None. G. Sendlhofer: None. B. Semlitsch: None. R. Riedl: None. T.R. Pieber: Advisory Panel; Self; ADOCIA, Arecor Limited, AstraZeneca, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; Novo Nordisk A/S. C. Tax: None. G. Brunner: None. J. Plank: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at